How do we improve survival from cardiac arrest?  Does Head-Up CPR improve outcomes?  Paul Pepe, the premier expert in the field, gives us the data and reasons why head-up CPR can improve outcomes.  Dr. Pepe also discusses estrogen and it’s potential to improve resuscitation outcomes.

On this 100th episode of EDECMO, Sydney’s very own Nat Kruit tells us how they organized a prehospital system.   She and her crew have a wonderful job organizing a cadre of new cannulators to now have a functional system that can provide the residents of Sydney the opportunity to benefit from ECPR.  Take a listen, she’s fantastic.

EDECMO – Episode 99 is a gem.  Charles Bruen tells us how he has become an ECPR cannulator within the prestigious Minnesota Mobile Resuscitation Consortium.  He shares pearls about cannulation as well as the next steps for Minnesota’s innovative approach to bringing ECPR to largest population that is possible.

A couple of pearls from Dr. Bruen’s cannulation piece are holding pressure in the groin with the ultrasound probe, understanding that the inguinal fold does not represent the inguinal ligament, inserting the needle at a 45-degree angle, and insertion at the common femoral artery.

Who Really Gets VV ECMO? Numbers, Nuance, and the Human Factor

Is VV ECMO purely a numbers game? Or is there a softer, more human side to deciding who receives this life-saving therapy? In this candid and insightful interview, Jon Marinaro sits down with the legendary Dr. Eddy Fan—one of the most published and respected voices in the field of critical care.

Together, they unpack the hard data and the gray areas: prognostic scoring, patient selection, and the ethical dilemmas that come with scarce resources. They also dive into the “sticky” dynamics of ECMO programs, including the subtle (or not-so-subtle) influence that a cannulating specialist can have on who actually gets the therapy.

This is a must-listen for anyone working at the intersection of critical care, ethics, and real-world ECMO decision-making.

Rubin J, Witkin AS, Crowley JC, Michel E, Furfaro DM, Teijeiro-Paradis R, Ilg A, Seethala R, Zhao S, Fan E. Venovenous Extracorporeal Membrane Oxygenation Candidacy Decision-Making: Lessons and Hypotheses From a Single-Center Observational Analysis. Chest. 2024 Sep;166(3):491-501. doi: 10.1016/j.chest.2024.02.042. Epub 2024 Feb 27. PMID: 38423278.

Combes A, Schmidt M, Hodgson CL, Fan E, Ferguson ND, Fraser JF, Jaber S, Pesenti A, Ranieri M, Rowan K, Shekar K, Slutsky AS, Brodie D. Extracorporeal life support for adults with acute respiratory distress syndrome. Intensive Care Med. 2020 Dec;46(12):2464-2476. doi: 10.1007/s00134-020-06290-1. Epub 2020 Nov 2. PMID: 33140180; PMCID: PMC7605473.

Jon interviews Dr. Stephen Wall from NYU on the podcast where they discuss the need for organs and how ECPR inclusion criteria can significantly impact the problem.

In our last episode, Trina Augustin discussed whether we should use a blender in ECPR patients citing the Blender Trial. This month we got the first author of the Blender Trial, Aidan Burrell, to give us insight into the use of blenders for not only ECPR patients but also thoughts on patients on VA for cardiogenic shock and VV patients. Jon Marinaro interviews Aidan for this wonderful addition to this complex decision.

Blender Trial – Burrell A, Ng S, Ottosen K, Bailey M, Buscher H, Fraser J, Udy A, Gattas D, Totaro R, Bellomo R, Forrest P, Martin E, Reid L, Ziegenfuss M, Eastwood G, Higgins A, Hodgson C, Litton E, Nair P, Orford N, Pellegrino V, Shekar K, Trapani T, Pilcher D. Blend to Limit OxygEN in ECMO: A RanDomised ControllEd Registry (BLENDER) Trial: Study Protocol and Statistical Analysis Plan. Crit Care Resusc. 2023 Aug 4;25(3):118-125. doi: 10.1016/j.ccrj.2023.06.001. Erratum in: Crit Care Resusc. 2024 Feb 01;26(1):60. doi: 10.1016/j.ccrj.2024.01.003. PMID: 37876374; PMCID: PMC10581278.

Trina’s editorial – Augustin K, Shinar ZM, Dos Reis Miranda D. Correspondence by Augustin et al. regarding the article “Conservative or liberal oxygen targets in patients on venoarterial extracorporeal membrane oxygenation”. Intensive Care Med. 2025 Jan 21. doi: 10.1007/s00134-025-07791-7. Epub ahead of print. PMID: 39836262.

This seems like such a basic question and yet the answer is not an answer at all.  Rather it is an educated opinion.  Today we ask the question – Should we blend ECPR patients?

Here’s the basic problem.  We think hyperoxemia in critically ill patients is bad (Remember hyperoxemia is high oxygen in blood, hyperoxia is high oxygen in the tissue).  We think that hypoxemia in critically ill patients is bad.  So if a patient gets put on ECMO and we can make the oxygen level coming out of the machine whatever level we want, what level should we set it at?

Well, today, Trina Augustin teaches how this seemingly simple problem is actually quite complex.  Trina is an ECMO superstar.  She practices at Mayo in Rochester as CV Intensivist with a background in CC/EM.  She teaches the most complex part of Reanimate – post pump critical care and yes she cannulates patients as well.  Listen to Zack and Trina banter over this complex topic specifically focusing on the release of the Blender Trial.

EMCRIT ECMO Podcast with Trina that is awesome! – CV-EMCrit – MCS Minute Series: Differential Gas Exchange on Peripheral Femoral VA ECMO with Trina

Bibliography:

Winiszewski H, Guinot PG, Schmidt M, Besch G, Piton G, Perrotti A, Lorusso R, Kimmoun A, Capellier G. Optimizing PO2 during peripheral veno-arterial ECMO: a narrative review. Crit Care. 2022 Jul 26;26(1):226. doi: 10.1186/s13054-022-04102-0. PMID: 35883117; PMCID: PMC9316319.

Bureau C, Schmidt M, Chommeloux J, Rivals I, Similowski T, Hékimian G, Luyt CE, Niérat MC, Dangers L, Dres M, Combes A, Morélot-Panzini C, Demoule A. Increasing Sweep Gas Flow Reduces Respiratory Drive and Dyspnea in Nonintubated Venoarterial Extracorporeal Membrane Oxygenation Patients: A Pilot Study. Anesthesiology. 2024 Jul 1;141(1):87-99. doi: 10.1097/ALN.0000000000004962. PMID: 38436930.

Burrell A, Ng S, Ottosen K, Bailey M, Buscher H, Fraser J, Udy A, Gattas D, Totaro R, Bellomo R, Forrest P, Martin E, Reid L, Ziegenfuss M, Eastwood G, Higgins A, Hodgson C, Litton E, Nair P, Orford N, Pellegrino V, Shekar K, Trapani T, Pilcher D. Blend to Limit OxygEN in ECMO: A RanDomised ControllEd Registry (BLENDER) Trial: Study Protocol and Statistical Analysis Plan. Crit Care Resusc. 2023 Aug 4;25(3):118-125. doi: 10.1016/j.ccrj.2023.06.001. Erratum in: Crit Care Resusc. 2024 Feb 01;26(1):60. doi: 10.1016/j.ccrj.2024.01.003. PMID: 37876374; PMCID: PMC10581278.

EDECMO episode 92 features Dr. Mark Dennis, a cardiologist from Sydney, who has published extensively in the field of ECPR.  Zack and Mark talk about so many subjects including pre-hospital considerations, algorithmic management of post ECMO initiation cardiac arrest patients, ventilation management of ECPR patients and much more.

Prof Dennis would like to thank all the ambulance paramedics, ED docs, intensive care specialists, surgeons, radiologists, nurses and cardiologists across Sydney. Without their support none of the work would be possible.

Also very special thanks to Natalie Kruit and Brian Burns for their immense efforts to bring ECPR to Sydney.

Blender Trial – Conservative or liberal oxygen targets in patients on venoarterial extracorporeal membrane oxygenation | Intensive Care Medicine

CO2 Drop in VA ECMO – ELSO Registry – Critical Care Medicine