quoteVV is, is markedly preferred. The, the best approach is to go VV unless you have specific reasons why you. Need to go VA.↗
▶Ep 4 · 2:37
clinicalVV ECMO is markedly preferred over VA ECMO unless there are specific reasons requiring VA support↗
▶Ep 4 · 2:37
clinicalVV ECMO provides normal left ventricular afterload and reduced risk for systemic emboli compared to VA ECMO↗
▶Ep 4 · 5:58
opinionHigh stroke rates in ECMO patients may be due to patient illness severity rather than specifically carotid cannulation↗
▶Ep 4 · 5:58
quoteyou can sit there messing around trying to knock can at the carotid when, when the best thing for them is to get on VA bypass and get them stabilized.↗
▶Ep 4 · 6:48
clinicalFor VA ECMO in patients over 35 kg, femoral cannulation or carotid-IJ may be used, though VV is strongly preferred↗
▶Ep 4 · 6:48
clinicalFor VA ECMO in children less than 35 kg, carotid-IJ cannulation is used at University of Michigan↗
▶Ep 4 · 7:29
clinicalSide graft (cortex) onto the subclavian artery is used routinely by many adult practitioners for ECMO access, avoiding leg complications↗
▶Ep 4 · 7:29
clinicalAt University of Michigan, posterior tibial artery cannulation is performed routinely in older ECMO patients for distal perfusion↗
▶Ep 4 · 9:28
clinicalThe Avalon catheter requires placement of the distal tip into the inferior vena cava, which is not easy to do↗
▶Ep 4 · 9:28
clinicalThe Avalon single cannula is well tolerated and allows more patient mobility↗
▶Ep 4 · 9:54
clinicalChest tubes should not be placed for pneumothorax in ECMO patients unless the patient is physiologically compromised or gas exchange is affected↗
▶Ep 4 · 9:54
quotewe've had plenty of chest tubes we placed. You put a chest tube in, I would say about half the time, you're going to end up doing a thoracotomy because of bleeding.↗
▶Ep 4 · 9:54
quotesit on your hands, don't put lines, don't put chest tubes unless you have to.↗
▶Ep 4 · 9:54
epidemiologicalApproximately 50% of chest tubes placed in ECMO patients result in bleeding requiring thoracotomy with chest packing↗
Summaries Ron gave as host
· 5 summaries
Recaps of other experts' statements, not Ron's own clinical position.
Summaries Ron gave as host · Extracorporeal Membrane Oxygenation5 summaries
host summaryRon Herschel summarizing a resource: In a registry of 30,000 patients, stroke rate with carotid cannulation is about 5%, compared to about 4% (1% less) without carotid cannulation↗
▶Ep 4 · 5:58
host summaryRon Herschel summarizing a resource: the stroke rate is about 5%. Um, if you cannulate the carotid, but look, the stroke rate, if you don't cannulate the carotid, is only about 1% less.↗
▶Ep 4 · 7:29
host summaryRon Herschel summarizing a resource: In a study of femoral artery cannulation in patients aged 2-22 years, 9 out of 11 patients developed limb ischemia even with distal perfusion cannula↗
▶Ep 4 · 7:29
host summaryRon Herschel summarizing a resource: even with a distal profusion cannula, they ended up in 9/11. 11 having ischemia.↗
▶Ep 4 · 8:40
host summaryRon Herschel summarizing a resource: For VV ECMO with separate femoral and IJ cannulas, draining from femoral and reinfusing into atrial (IJ) minimizes recirculation compared to the reverse configuration↗
