I had the opportunity to attend a conference – Reanimate 2016 – in order to learn more about this modality, how it is being applied in the ED for cardiac arrest patients and how Sharp Memorial Hospital in San Diego, CA, has improved their cardiac arrest survival rates regardless of the use of ECMO.
What is ECMO?
VA ECMO consists of three major components:
- A pump (below left) using either a rotary or centrifugal motor
- An oxygenator (below top right, red arrow)
- An arterial and venous cannula (below bottom right)
Once inserted, the venous cannula creates negative pressure via the motor which brings ‘venous’ blood into the oxygenator, the blood is then oxygenated and forced, in a retrograde fashion, out of the arterial catheter which then perfuses the coronary and cerebral arteries (see below).
This system is also very lightweight and portable. Sufficiently so, that it is currently being used for pre-hospital and inter-hospital transport via both land and air ambulance (below left).
Who gets put on ECMO for OHCA
Does ECMO work for OHCA?
As you can imagine, it is extraordinarily difficult to perform a randomized controlled trial (RCT) on ECMO based on the low frequency of its use in OHCA and very high mortality of patients if it is not instituted. Multiple case reports, case series and observational trials have demonstrated efficacy of ECMO for OHCA.
What about Sharp?
- ‘Pit-Crew CPR’ (Hopkins et al., 2016; Prince, Hines, Chyou, &Heegeman, 2014)
- RN-led codes (Gilligan et al., 2005)
- Mechanical CPR devices (Perkins, Lall, Quinn, & Deakin, 2015)
- Insertion of femoral venous and arterial lines in every OHCA
But who would ED ECMO affect at your hospital?
- ED MD’s, RN’s, RT’s, Porters, Clerks, etc
- Cardiac Surgery ICU
- Cardiac Anesthesia
- Cardiothoracic Surgery
- Hospital Administration
- Resource intensive
- Real-estate (where do the patient’s go once on ECMO)
- Availability of CV surgery OR’s