ECPR / ECMO Resources

This page is currently a work in progress…..

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

Current SCGH Inclusion / Exclusion Criteria for ECPR:

Main ECPR Resources:

• Alfred ECMO Resources webpage
  • Alfred ICU ECMO Guideline
  • Alfred ECMO-CPR Guideline
  • Alfred ECMO Setup Guidelines
• EDECMO.org website
• Extracorporeal Life Support Organization (ELSO)
  • Extracorporeal Life Support Organization (ELSO): General Guidelines for all ECLS Cases
  • Extracorporeal Life Support Organization (ELSO): Guidelines for ECPR Cases

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:

ECPR Roles:

Alfred ICU ECPR Role Cards:

• 7 roles of a standard ACLS team:
  • Airway doctor
  • Airway assistant
  • CPR
  • Defibrillation 
  • Scribe
  • Drug administration
  • Team leader
    
    

• 4 specific roles for the Cannulation team:
  • Cannulator 1 – the primary cannulator
  • Cannulator 2 – the assistant cannulator
  • ECMO console operator
  • Sonographer

Cannulation:

• Maquet HLS Cannulae link

• 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:

• Maquet Cardiohelp (HLS) System
  • Basic training document
• PLS System

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:

• EDECMO.org literature list

Course / Conferences:

• The Alfred ICU and Perfusion Adult ECMO Course
• Reanimate Conference
• ELSO Courses / Conferences & Collaborative Meetings