Explanation:
Yes, this patient would be great for ECPR (refractory arrest, “ECMO Alert”).
Explanation:
Yes, this patient does not have any obvious exclusion criteria. Her arrest was witnessed, bystander CPR was started and she fits into the age range.
Explanation:
Veno-venous (VV) ECMO and Veno-arterial (VA) ECMO. VV ECMO is used to replace the lungs but still uses the heart as a pump for the blood. VA ECMO replaces both the heart and the lungs and ECMO works as the pump.
Explanation:
No. You have already achieved ROSC. This patient may ultimately be placed on ECMO, but to support his lungs after drowning. A few days after drowning, patients can have worsening lungs and may be placed on VV ECMO. If he were to lose pulses again, then you can consider ECPR (refractory arrest, “ECMO Alert”) as he does not have any exclusion criteria.
Explanation:
There are some concerning risks and downsides associated with ECMO and eCPR:
Bleeding
Trauma to vessels
Needle sticks and exposures to healthcare workers during cannulation
Can be confusing and overwhelming to the patient’s family
Very resource intensive and expensive
But there are benefits as well: Increased neurologically intact survival from cardiac arrest
Explanation:
No, ECMO and bypass are not the same. They have similar functions but are operationally very different.
Explanation:
No, ECPR (refractory arrest, “ECMO Alert”) is ECMO. Specifically, ECMO is used when someone is in cardiac arrest. Other uses of ECMO do not require the patient to be in cardiac arrest, such as profound lung pathology. ECMO is just the tool used in ECPR (refractory arrest, “ECMO Alert”).
Explanation:
ECMO does not actually “treat” anything. ECMO is used as a bridge to fix the actual problem. ECMO buys you time to figure out what is killing your patient. In some cases, it buys the patient time to heal. Sometimes, our patient’s lungs just need a break. For example, when used during refractory V-fib arrest treatment, it allows us to support the patient and oxygenate the brain while we take the patient to the cath lab to hopefully unblock one of the coronary arteries. It acts as a bridge and buys more time to solve the problem.
Explanation:
Yes, there is a protocol.
Inclusion Criteria:
- Age 18-75 years old
- Initial shockable rhythm (VF/VT/AED advised shock)
- Witnessed arrest by bystanders or prehospital personnel
- Suspected cardiac cause of arrest
- Body habitus allows LUCAS CPR (must be used for transport)
- FULL CODE
Exclusion Criteria:
- Permanent resident of a skilled nursing facility (i.e. nursing home)
- Known pre-existing organ failures or co-morbidities that would prevent a return to independent living
Explanation:
No, this patient would not be a good candidate for ECPR (refractory arrest, “ECMO Alert”). The patient is excluded due to age and residing in a nursing home. As a reference, ECMO for any indication is not recommended for patients older than 75 years old.
Explanation:
No, this patient has end-stage-renal-disease and is on dialysis so this would exclude her from ECPR (refractory arrest, “ECMO Alert”).