French And Aussie ECPR

Question 1

Aim of prehospital ECPR

Answer 1

Reduce time transporting to ECPR centre, so ECPR can be started earlier decreasing low flow time

Question 2

ECPR

Answer 2

Using ecmo during CA

Question 3

Main predictors for outcome

Answer 3

Rhythm
Duration of no flow (no CPR)
Duration of low flow (need <60mins for consistent benefit)

Question 4

Target population for ECPR

Answer 4

Refractory VF

Question 5

Chanllenges of prehospital ECPR

Answer 5

High complexity
Low frequency
Time pressured
Equity of access
Few ECMO centres
No accreditation standard

Question 6

ECMO ALS

Answer 6

No rhythm checks
No further defibrillation
No further adrenaline

Question 7

Advantages and disadvantages of ECMO ALS

Answer 7

Increases chance of successful ECPR cannulation
Risk that ECPR ALS prevents ROSCa via normal ALS is unsuccessful

Question 8

What should be checked after starting ECPR

Answer 8

Adequacy of foreward flow
- brachial pulse, spo2, NIBP, colour, end tidal

Question 9

ECPR selection criteria

Answer 9

Witnessed collapse
Effective immediate cpr
Initial VF/VT OR PEA+signs of life
Age <70
Consider frailty
Can you confidently cannulate

Question 10

Parts of ecmo circuit

Answer 10

Oxygenator
Centrifugal pump
2 large bore cannula

Question 11

What drug is given when setting up ECMO

Answer 11

5000 IU heparin
More given if 1 hr since last dose, no ejection,m long transport, obese

Question 12

Purpose of USS guided compressions

Answer 12

TOE to assess whether CPR is effectively compressing LV
Locate area of max compression
Prevent compression of great vessels
TOE can be used while compressions ongoing
Anatomical variation in LV location can affect whether CPR with standard hand placement is effectively compressing

Question 13

What is a major issue in using ECPR in children

Answer 13

Most children have hypoxic arrest which doesnt meet inclusion criteria