EDECMO 20 – The Golden Hour & the Rule of 3’s: Optimizing the Critical First Hour on Heart-Lung Bypass

What this episode covers

Announcements Upcoming Conferences: * SMACC 2015: June 23-26, 2015. The biggest and baddest critical care conference of the year is in Chicago this year. * Essentials of Emergency Medicine 2015 . October 13-15, 2015. The Big Show. In Vegas. At the Cosmopolitan. * Reanimate San Diego. February 25-26, 2016. The essentials of ECMO in 2 glorious days. Here is a sneak peak at the Reanimate 2016 Promo Video. Flipped Classroom SMACC ECMO Workshop 2015 For those taking the upcoming ECMO courses with us, download both of these 2 attachments. The first is a diagram of a traditional ECMO circuit - its nice to print this out and follow along. Not every circuit is the same and we have ours custom built by Maquet. The second is a self-study course. While it isn't necessary to review these before our workshop, it will really put you ahead of the game and we focus more on procedures. Figure 1. The Custom Maquet ECMO Circuit Study Guide Review of the 3 stages of ECPR * STAGE 1: Placement of any commercially available vascular catheter in the femoral vein and femoral artery * STAGE 2: Replacement of each catheter with ECMO cannulae. Checkout EDECMO 5: Cognitive Task Management for ED ECMO Stages 1 and 2 . Also, we learned several cannulation pearls from Stephen Bernard in EDECMO 14 Part 1 and Part 2 * STAGE 3: Initiation of Total Heart Lung Bypass ECMO Circuit Setup: * Plug in the machine and power-on the heater-cooler and the Rotaflow console. * Unpackage the circuit and hold it up to orient yourself. * Mounting the Rotaflow Pump to the Pump Drive Attach the Oxygenator to the bracket and the pump to the pump-drive; hang the distal ends of the circuit (the tubes that will connect to the patient) from the IV pole. * Apply ultrasonic contact cream to the flow probe contact site * Remove and DISCARD the yellow de-airing exit port cap on the top of the oxygenator. * Connect the water lines from the heater-cooler to the Quadrox Oxygenator & open the stopcocks. * "Run the circuit", making sure that the recirculation bridge is OPEN, arterial and venous tubing is CLAMPED, rapid-prime tubes are CLAMPED, both of the blood sampling "pig tail" stopcocks are CLOSED. * PRIME the circuit: Priming the Circuit: Filling the ECMO circuit (tubing, pump, oxygenator) with crystalloid priming solution (ie Isolyte), adding 2,500 units of heparin to each 1-liter bag of priming solution. We discuss the finer details of this with Greg Griffin, the Chief Perfusionist at the University of North Carolina, Chapel Hill in EDECMO 8 . * squeeze all air out of prime bag INTO the circuit and then hang those bags from the IV pole. * Open the ratchet clamps: the circuit will fill (prime) by gravity...

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