<hr />
ED ECMO Podcast — Episode Synopsis
This episode of ED ECMO, hosted by Zack Shinar, explores the emotional, neurological, and psychiatric outcomes of ECPR and ECMO survivors — going beyond survival statistics to examine what it means for patients to truly live after ECMO.
Segment 1: ECPR Training & the Delphi Analysis (with Shan Modi) Shan Modi, critical care physician and associate ECMO medical director at Allegheny General Hospital, discusses a multinational Delphi analysis surveying 50–55 ECPR experts across 20–25 countries to establish standardized learning objectives for ECPR cannulators. He and Zack then pivot to Shan’s commentary on an EXCEL registry study that prospectively examined quality of life in ECMO patients — revealing that 70% of ECMO patients either develop a new disability or die from comorbidities, underscoring the gap between binary survival and meaningful recovery.
Segment 2: The Emotional Landscape of Survivors Zack and Shan discuss recurring emotional patterns in ECPR survivors:
<ul>
<li>Fear of sleeping after arrest, worried it could happen again</li>
<li>Survivor’s remorse — patients feeling disconnected from celebration because they “just went to sleep and woke up”</li>
<li>Anxiety and depression months after discharge</li>
<li>The ethical concern of advertising patients as “survivors” when they may prefer to simply return to normal life</li>
</ul>
Segment 3: Post-ICU Care & Caregiver Burden Shan advocates for dedicated post-ICU clinics for ECMO patients (modeled on Dr. Brad Butcher’s work at Pittsburgh), offering multidisciplinary follow-up with PT, OT, social work, and psychiatry. He also shares early findings from his ongoing caregiver interview study (24 caregiver-patient dyads), revealing that caregivers face acute-phase overwhelm and subacute-phase stress, financial strain, and guilt over struggling to care for themselves while caring for their loved one.
Segment 4: Neurological & Psychiatric Outcomes (with Dr. Sung Min Cho) Dr. Sung Min Cho, neurointensivist at Johns Hopkins and co-founder of the Whitman-Cho ECMO research lab, discusses:
<ul>
<li>Acute Brain Injury (ABI) rates far exceeding ELSO registry reports — meta-analysis showing 17% in VA ECMO, 10% in VV, and 20–50% in ECPR</li>
<li>Neuropsychiatric symptoms (insomnia, depression, anxiety) persisting in 30–40% of survivors at 6–12 months</li>
<li>Lack of pulsatility in VA ECMO causing small vessel brain injury, analogous to known LVAD complications</li>
<li>Rapid CO2 correction during ECMO initiation linked to hemorrhagic and ischemic stroke, confirmed in a swine model showing basal ganglia injury</li>
<li>The Safe MRI ECMO Study — a multi-center trial using bedside low-field MRI (0.064 Tesla) on patients while on ECMO, finding a striking 44% ABI rate, far higher than any prior study, revealing subclinical injuries invisible on standard CT scans (<a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC11627327/pdf/cir-150-1955.pdf">cir-150-1955.pdf, </a><a href="https://pubmed.ncbi.nlm.nih.gov/39342513/">Clinical Use of Bedside Portable Ultra-Low-Field Brain Magnetic Resonance Imaging in Patients on Extracorporeal Membrane Oxygenation: Results From the Multicenter SAFE MRI ECMO Study – PubMed</a>)</li>
</ul>
Segment 5: VV vs. VA Differences & Take-homes VV ECMO patients showed higher neurocognitive impairment, likely due to longer hospitalization, heavier sedation, and prolonged paralysis. Key recommendations for ECMO programs:
<ul>
<li>Optimize initiation parameters (sweep gas, CO2 correction rate, pulsatility monitoring)</li>
<li>Minimize sedation and benzodiazepine duration</li>
<li>Establish long-term follow-up and support groups for survivors</li>
<li>Recognize that neurocognitive sequelae are common — patients should know they are not alone</li>
</ul>
The episode closes with both guests reflecting on how ECMO uniquely brings together diverse specialties — ED, surgery, critical care, engineering — unified around saving the sickest patients.

ED ECMO Podcast — Episode Synopsis This episode of ED ECMO, hosted by Zack Shinar, explores the emotional, neurological, and psychiatric outcomes of ECPR and ECMO survivors — going beyond survival statistics to examine what it means for patients to truly live after ECMO. Segment 1: ECPR Training & the Delphi Analysis (with Shan Modi) Shan Modi, critical care physician and associate ECMO medical director at Allegheny General Hospital, discusses a multinational Delphi analysis surveying 50–55 ECPR experts across 20–25 countries to establish standardized learning objectives for ECPR cannulators. He and Zack then pivot to Shan’s commentary on an EXCEL registry study that prospectively examined quality of life in ECMO patients — revealing that 70% of ECMO patients either develop a new disability or die from comorbidities, underscoring the gap between binary survival and meaningful recovery. Segment 2: The Emotional Landscape of Survivors Zack and Shan discuss recurring emotional patterns in ECPR survivors: Fear of sleeping after arrest, worried it could happen again Survivor’s remorse — patients feeling disconnected from celebration because they “just went to sleep and woke up” Anxiety and depression months after discharge The ethical concern of advertising patients as “survivors” when they may prefer to simply return to normal life Segment 3: Post-ICU Care & Caregiver Burden Shan advocates for dedicated post-ICU clinics for ECMO patients (modeled on Dr. Brad Butcher’s work at Pittsburgh), offering multidisciplinary follow-up with PT, OT, social work, and psychiatry. He also shares early findings from his ongoing caregiver interview study (24 caregiver-patient dyads), revealing that caregivers face acute-phase overwhelm and subacute-phase stress, financial strain, and guilt over struggling to care for themselves while caring for their loved one. Segment 4: Neurological & Psychiatric Outcomes (with Dr. Sung Min Cho) Dr. Sung Min Cho, neurointensivist at Johns Hopkins and co-founder of the Whitman-Cho ECMO research lab, discusses: Acute Brain Injury (ABI) rates far exceeding ELSO registry reports — meta-analysis showing 17% in VA ECMO, 10% in VV, and 20–50% in ECPR Neuropsychiatric symptoms (insomnia, depression, anxiety) persisting in 30–40% of survivors at 6–12 months Lack of pulsatility in VA ECMO causing small vessel brain injury, analogous to known LVAD complications Rapid CO2 correction during ECMO initiation linked to hemorrhagic and ischemic stroke, confirmed in a swine model showing basal ganglia injury The Safe MRI ECMO Study — a multi-center trial using bedside low-field MRI (0.064 Tesla) on patients while on ECMO, finding a striking 44% ABI rate, far higher than any prior study, revealing subclinical injuries invisible on standard CT scans (cir-150-1955.pdf, Clinical Use of Bedside Portable Ultra-Low-Field Brain Magnetic Resonance Imaging in Patients on Extracorporeal Membrane Oxygenation: Results From the Multicenter SAFE MRI ECMO Study – PubMed) Segment 5: VV vs. VA Differences & Take-homes VV ECMO patients showed higher neurocognitive impairment, likely due to longer hospitalization, heavier sedation, and prolonged paralysis. Key recommendations for ECMO programs: Optimize initiation parameters (sweep gas, CO2 correction rate, pulsatility monitoring) Minimize sedation and benzodiazepine duration Establish long-term follow-up and support groups for survivors Recognize that neurocognitive sequelae are common — patients should know they are not alone The episode closes with both guests reflecting on how ECMO uniquely brings together diverse specialties — ED, surgery, critical care, engineering — unified around saving the sickest patients.

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ED ECMO Podcast — Episode Synopsis
This episode of ED ECMO, hosted by Zack Shinar, explores the emotional, neurological, and psychiatric outcomes of ECPR and ECMO survivors — going beyond survival statistics to examine what it means for patients to truly live after ECMO.
Segment 1: ECPR Training &amp; the Delphi Analysis (with Shan Modi) Shan Modi, critical care physician and associate ECMO medical director at Allegheny General Hospital, discusses a multinational Delphi analysis surveying 50–55 ECPR experts across 20–25 countries to establish standardized learning objectives for ECPR cannulators. He and Zack then pivot to Shan’s commentary on an EXCEL registry study that prospectively examined quality of life in ECMO patients — revealing that 70% of ECMO patients either develop a new disability or die from comorbidities, underscoring the gap between binary survival and meaningful recovery.
Segment 2: The Emotional Landscape of Survivors Zack and Shan discuss recurring emotional patterns in ECPR survivors:
<ul>
<li>Fear of sleeping after arrest, worried it could happen again</li>
<li>Survivor’s remorse — patients feeling disconnected from celebration because they “just went to sleep and woke up”</li>
<li>Anxiety and depression months after discharge</li>
<li>The ethical concern of advertising patients as “survivors” when they may prefer to simply return to normal life</li>
</ul>
Segment 3: Post-ICU Care &amp; Caregiver Burden Shan advocates for dedicated post-ICU clinics for ECMO patients (modeled on Dr. Brad Butcher’s work at Pittsburgh), offering multidisciplinary follow-up with PT, OT, social work, and psychiatry. He also shares early findings from his ongoing caregiver interview study (24 caregiver-patient dyads), revealing that caregivers face acute-phase overwhelm and subacute-phase stress, financial strain, and guilt over struggling to care for themselves while caring for their loved one.
Segment 4: Neurological &amp; Psychiatric Outcomes (with Dr. Sung Min Cho) Dr. Sung Min Cho, neurointensivist at Johns Hopkins and co-founder of the Whitman-Cho ECMO research lab, discusses:
<ul>
<li>Acute Brain Injury (ABI) rates far exceeding ELSO registry reports — meta-analysis showing 17% in VA ECMO, 10% in VV, and 20–50% in ECPR</li>
<li>Neuropsychiatric symptoms (insomnia, depression, anxiety) persisting in 30–40% of survivors at 6–12 months</li>
<li>Lack of pulsatility in VA ECMO causing small vessel brain injury, analogous to known LVAD complications</li>
<li>Rapid CO2 correction during ECMO initiation linked to hemorrhagic and ischemic stroke, confirmed in a swine model showing basal ganglia injury</li>
<li>The Safe MRI ECMO Study — a multi-center trial using bedside low-field MRI (0.064 Tesla) on patients while on ECMO, finding a striking 44% ABI rate, far higher than any prior study, revealing subclinical injuries invisible on standard CT scans (<a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC11627327/pdf/cir-150-1955.pdf" rel="noopener noreferrer">cir-150-1955.pdf, </a><a href="https://pubmed.ncbi.nlm.nih.gov/39342513/" rel="noopener noreferrer">Clinical Use of Bedside Portable Ultra-Low-Field Brain Magnetic Resonance Imaging in Patients on Extracorporeal Membrane Oxygenation: Results From the Multicenter SAFE MRI ECMO Study – PubMed</a>)</li>
</ul>
Segment 5: VV vs. VA Differences &amp; Take-homes VV ECMO patients showed higher neurocognitive impairment, likely due to longer hospitalization, heavier sedation, and prolonged paralysis. Key recommendations for ECMO programs:
<ul>
<li>Optimize initiation parameters (sweep gas, CO2 correction rate, pulsatility monitoring)</li>
<li>Minimize sedation and benzodiazepine duration</li>
<li>Establish long-term follow-up and support groups for survivors</li>
<li>Recognize that neurocognitive sequelae are common — patients should know they are not alone</li>
</ul>
The episode closes with both guests reflecting on how ECMO uniquely brings together diverse specialties — ED, surgery, critical care, engineering — unified around saving the sickest patients.

EDECMO 107: Emotional Aspect of ECPR Survivorship

EDECMO # 13 – Does Pseudo-PEA Exist and What Should You Do About It

Zack and Joe and discuss two high-impact articles that compare conventional CPR to ECPR.

Evid-ECMO (Evidence for ECMO): Critical Analysis of the ECMO literature #1

In this episode Joe talks with Suzanne Chillcott, the Mechanical Circulatory Support (MCS) Lead RN at Sharp Memorial Hospital to discuss the nuts and bolts of establishing a "nurse-run" ECLS program.

EDECMO Episode 12 – The Nurse-Based ECMO Program at Sharp Memorial Hospital with Suzanne Chillcott RN, BSN

Video Promo for the "Bring Me Back to Life" conference coming up on October 21, 2014 in Montreal!

Video: “Bring Me Back to Life” Conference in Montreal; October 21, 2014

EDECMO Episode 11 – The Paris ECMO Course

The ED ECMO Project is the work of Zack Shinar and Jon Marinaro to bring extracorporeal life support to EDs and ICUs around the world. This site aims to be the ultimate resource for the background, logistics, and evidence for resuscitative ECMO.

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