Critical Matters ECPR
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Aug 14, 2025 Dr. Adam Green, a practicing intensivist and associate professor at Cooper University, joins Dr. Sergio Zanotti to discuss the growing relevance of Extracorporeal Cardiopulmonary Resuscitation (ECPR). They delve into the evolution of ECMO practices, emphasizing patient selection and timing during cardiac arrest. Green highlights the ethical complexities in critical care decisions and the vital role of effective communication with families. The discussion also touches on emerging insights around patient outcomes and the rapid protocols that shape life-saving interventions.
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Recognize Harlequin Syndrome Early
- Harlequin (north-south) syndrome arises when recovering native cardiac output ejects poorly oxygenated blood to the brain.
- Monitor right radial arterial oxygenation to detect cerebral hypoxemia early.
Anticipate Blunted Fever Responses
- Be alert for atypical infection signs because ECMO circuits and external heat exchangers blunt fevers.
- Use low threshold to start antibiotics and watch for bandemia as an infection signal.
Wean With Echo-Guided Ramp Trials
- Wean ECMO via echo-guided ramp trials, slowly reducing flow while assessing MAP and ventricular function.
- Decannulate when native cardiac function sustains hemodynamics without excessive ECMO flow.
