tag:blogger.com,1999:blog-549949223388475481.post3931826824907048231..comments2024-03-28T14:02:08.119-05:00Comments on Dr. Smith's ECG Blog: Refractory V FIb Arrest, put on ECMO, regains an organized rhythm, and a 12-lead is recorded.Unknownnoreply@blogger.comBlogger10125tag:blogger.com,1999:blog-549949223388475481.post-17213263592435360732017-06-09T07:12:43.595-05:002017-06-09T07:12:43.595-05:00One randomized trial years ago showed no benefit. ...One randomized trial years ago showed no benefit. Can't hurt to try it except that it costs $6000.00Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-44911043892566376742017-06-08T17:51:25.012-05:002017-06-08T17:51:25.012-05:00dr smith, this there in role of thromblysis in car...dr smith, this there in role of thromblysis in cardiac arrest put due to acute coronary syndrome with bedside cardiac ultrasound no precordial effusion ?Anonymoushttps://www.blogger.com/profile/03078282266265164156noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-8124790104634098012017-05-27T05:54:17.844-05:002017-05-27T05:54:17.844-05:00Thanks, Alain!Thanks, Alain!Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-17929494402610763742017-05-27T05:54:08.511-05:002017-05-27T05:54:08.511-05:00Thanks, Dominic!Thanks, Dominic!Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-19372482237638659862017-05-24T20:59:00.913-05:002017-05-24T20:59:00.913-05:00There was complete cardiac standstill (not just ve...There was complete cardiac standstill (not just very low ef). I think also some technical issues with the circuit and bleeding. I was not involved in this decision making bacause the patient's care was transfered to the cardiologist specialised in hemodynamics.Dominic Larose MD CMFC(MU) FACEPhttps://www.blogger.com/profile/12841805037815499459noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-10710111715036964002017-05-24T20:18:43.144-05:002017-05-24T20:18:43.144-05:00This is a good question. We currently have ED time...This is a good question. We currently have ED times of 5-10 minutes in the daytime for STEMI or when cath lab is ready, and serve as a stabilization room when we're waiting for cathlab. So it's mostly a parallel task. For ECMO starting, after reviewing the cases, it looks easier to start them in the ED and transfer as started than in the cath lab. This is a small number of cases, but we decided to complete the ECMO part before cathlab transfers. Alain Vadeboncoeurhttps://www.blogger.com/profile/06938164177722777952noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-63812125323503667452017-05-24T17:21:16.887-05:002017-05-24T17:21:16.887-05:00Everything depends on the availability of resource...Everything depends on the availability of resources. Does it take longer to get the cath lab ready than to start ECMO? Then start ECMO now. If the other way around, you have to decide if you want to do angiography during CPR (it can be done, but not as easily). If your CPR is very high quality, as in this case (measure by arterial line, etCO2, cerebral perfusion monitor, pulse oximetry), then you have time.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-2377723360479373852017-05-24T06:50:26.150-05:002017-05-24T06:50:26.150-05:00In our hospital patients with OHCA are generally (...In our hospital patients with OHCA are generally (although they are not that many...) transported directly to the cathlab if there is agreement that more aggressive treatment could be helpful. Then coronary angiography and possibly av-ECMO is performed in the cath lab (by interventional cardiologist sometimes with help of CT surgeon). Doesn't initiation of ECMO in the ED risk delaying PCI, which would likely be the most common "fixable" problem in these patients (except perhaps in the very young with perhaps arrhytmogenic causes and myocarditis)? What are the thoughts of you who practice ED ECMO?Anonymoushttps://www.blogger.com/profile/17146410879918341599noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-71334217411114390552017-05-24T05:41:04.035-05:002017-05-24T05:41:04.035-05:00Good question, but I'm sorry I do not have the...Good question, but I'm sorry I do not have the answer.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-48022067044195599392017-05-22T18:45:25.450-05:002017-05-22T18:45:25.450-05:00Why was ECMO discontinued so early, was the patien...Why was ECMO discontinued so early, was the patients age a factor in that he would not have been accepted into a transplantation or LVAD programme or was a head CT showing catastrophic neurological damage or documented clinical brain death?Bobhttps://www.blogger.com/profile/06063040476449364818noreply@blogger.com