EMCrit Podcast EMCrit Podcast 265 - ECPR 2.0
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Feb 5, 2020 Scott Weingart, critical care and resuscitation expert, outlines eCPR 2.0 and how modern ECMO practice has evolved. They cover percutaneous ultrasound cannulation, smaller arterial cannulae and simpler circuits, early CT and limb perfusion strategies, lower flow and permissive MAP goals, delayed prognostication, and the team culture and resource commitments needed for success.
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Search Early For CPR Injuries With CT
- Routinely perform an early CT scan after cannulation to look for CPR-related injuries.
- Empiric CT (or a CT stop before ICU/cath lab) finds hemothorax, rib fractures, or other occult injuries before they cause deterioration.
Mandate Early Leg Perfusion
- Place mandatory limb perfusion/backflow cannula to the cannulated leg within hours of VA ECMO initiation.
- Early back cannula prevents limb ischemia which has caused otherwise neurologically intact patients to die on day two.
Use Lower Anticoagulation Targets
- Target lower anticoagulation goals on modern ECMO circuits to reduce bleeding.
- Newer membranes allow less aggressive anticoagulation than older eras, lowering hemorrhagic complications in eCPR patients.