ECPR / ECMO Resources

This page is currently a work in progress…..

 

Current SCGH ED ECMO Protocol for Out-Of-Hospital Cardiac Arrest:

 

Main ECPR Resources:

 

 

Current SCGH Inclusion / Exclusion Criteria for ECPR:

 

Note: After receiving the SJA priority phone call, you should check the SJA Portal (via computer opposite T2 – User ID on back, RSA key as per dongle) prior to arrival to determine accurate times (SJA call / crew arrival / crew departure) and check iSOFT for previous medical history.

 

 

Equipment:

SCGH ED Box:

  • ECMO Role Cards
  • Gloves, gowns and masks x 3
  • Major Anaesthetic Pack x 1
  • Gauze
  • Betadine cleaning solution
  • Bifemoral Drape (Lifemed Patient Drape Universal Fem. Angiography) x 2
  • Ultrasound Probe Cover Long x 2
  • Medtronic cannula and dilator sets:
    • single stage arterial 17 Fr x1 (15 Fr available in compactors)
    • multistage venous 21 Fr (19 Fr available in compactors)
    • additional dilator sets
    • additional guide wires (1 & 1.5m)
  • Backflow cannula 7-9 Fr (Super Arrowflex Percutaneous Sheath Introducer Set)
  • Mosquito forceps 12.5cm x 4
  • Sterile clamps 18cm x 4
  • 60ml Syringe with nozzle x 2
  • 20000U of heparin (10000 / litre)
  • 2L normal saline
  • Bowl 8L Sterile (for mixing saline and heparin)
  • Griplok dressings (universal medium size) x 4
  • Tube cutting scissors x 2
  • Cable ties x 8

Presentations:

 

ECPR Talk by Vin Pellegrino 2016:

The Slides:

Making ECPR Happen -Jason McClure from Social Media and Critical Care on Vimeo.

 

 

ECPR Roles:

 

Alfred ICU ECPR Role Cards:

 

 

Cannulation:

 

 

  • Preferable to place venous and arterial cannulas in opposite limbs because:
    • there is an increase need for venous drainage of leg with distal perfusion SFA cannula and this can be compromised by venous line placement in the same leg.
    • ??cut down repair of the artery during de-cannulation is easier without the venous cannula in the way, and venous cannula can be de-cannulated without cut down if it is in a separate groin.

 

  • US guided Percutaneous vs Open Cannulation:
    • Adv of US guided Percutaneous:
      • decreased risk of infection
      • decreased risk of bleeding
      • easier to secure
      • can be placed more easily during CPR
    • Disadv of US guided Percutaneous:
      • requires ultrasound competency
      • may fail

 

  • Backflow Catheter ? cook access plus 9Fr

 

Pumps:

 

Pump settings to maintain flows to maintain venous saturations of >70% (= best measure of systemic perfusion) – usually ~3 L/m2/min / ~60ml/kg/min for adults (~4-5 L/min for 70kg adult)

 

 

Circuit Priming:

 

PLS Priming video (The Alfred)

 

 

HLS (Cardiohelp) Priming:

Evidence:

 

Course / Conferences:

 

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