The PerfWeb Podcast

The learner will be able to describe how fluid overload is an independent contributor and indicator of mortality.

How ECMO contributes to maintaining kidney dysfunction and casually participates in the development of AKI (Acute Kidney Injury)

The learner will be able to describe the physiologic principles of urine production and discuss how cardiopulmonary bypass affects urine production and the potential development of Acute Kidney Injury (AKI). Urine Production. Renal Anatomy. Nephron What is Acute Kidney Injury? It is the SUDDEN decrease in renal function that leads to the build-up of waste in the blood, fluid overload, and electrolyte imbalances. What are the causes of Acute Kidney Injury? There are three causes, which are based on location. The first is known as prerenal injury and this is an issue with the perfusion to the kidneys that leads to decreased renal function. A second cause is known as intrarenal injury, and this is due to damage to the nephrons of the kidney. Lastly, postrenal injury is due to a blockage located in the urinary tract after the kidney that can extend to the urethra. This is causing the backflow of urine, which increases the pressure and waste in the kidneys. Stages of Acute Kidney Injury: There are four stages of acute kidney injury, which include initiation, oliguric, diuresis, and recovery stage. The initiation stage starts when a cause creates an injury to the kidney and then signs and symptoms start to appear. This leads to the oliguric stages. The patient will void less than 400 mL/day of urine during this stage and will experience increased BUN/creatinine levels, azotemia, hyperkalemia, hypervolemia, increase phosphate, and decreased calcium levels along with metabolic acidosis. After this stage, the patient can progress to the diuresis stage and this is where the patient will void 3-6 Liters of urine per day due to osmotic diuresis. The patient is at risk for hypokalemia, dehydration, and hypovolemia. The last stage is recovery and the patient's glomerular filtration rate has returned to normal. Therefore, the kidneys are able to maintain normal BUN and creatinine levels, electrolyte, and water levels.

The learner will be able to discuss what Acute Kidney Injury (AKI) is and the factors that influence its development. The learner will be able to discuss the RIFLE, AKIN, and KDIGO criteria for assessing AKI.

Lively lecture and discussion about Extracorporeal Membrane Oxygenation (ECMO) survival data and how patient selection and timing of ECMO initiation contributes to improving ECMO outcomes.

Comprehensive discussions about the various devices used to deliver ECMO therapy.

Matt Warhoover, CCP; Perfusion program director at Vanderbilt University discusses staffing models for ECMO departments. Nursing Based ECMO Staffing Model, Respiratory Therapist Based ECMO Staffing Model, Perfusion Based ECMO Staffing Model, Hybrid Base ECMO Staffing Model Pros and cons.

Joe Basha, CCP lectures on Extracorporeal Membrane Oxygenation (ECMO) safety and discussions on ECMO circuit design to minimize risks. ECMO Circuit examples: VA ECMO, VV ECMO, VVA ECMO, VAV ECMO, VVAV ECMO, and VVVA ECMO.

The learner will be able to discuss plasma adsorption therapy and how this benefits patients suffering Systemic Inflammatory Response Syndrome (SIRS). Our bodies are very good at fighting infections. The immune system reacts and attacks the bacteria and viruses that make us sick. But sometimes the immune reaction is so strong that it damages the body too. This is called a septic reaction, or sepsis. And the mortality rate associated with it can be high. They've organized a sepsis response team in the intensive care unit. Their goal: to stop sepsis and save lives.

The learner will be able to discuss anticoagulation strategies for patients on ECMO.