Making ECPR Happen
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A demonstration in the ECMO-CPR process and then going back to basics, to understand the need for such a process and how to design and develop it from scratch using simulation to cut lead time and highlight and remove issues prior to rolling out on the patients. Making E-CPR both possible and safer.
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Making ECPR Happen
- 2. Cue Audio
- 10. Dilatation
- 12. Cannulation
- 14. 4501 12 july 14 Cannula Positioning
- 18. Connection with underwater seal
- 22. E-CPR: Making it happen Jason McClure
- 23. The Alfred ICU
- 25. ECMO ECMO CPR
- 28. Issues with ECPR Time critical & stressful Infrequent Highly technical Large Number of Staff 24/7
- 29. CPR to ED (Autopulse) Hypothermia ECPR Emergency Reperfusion
- 32. Our Method Identify Problems in Realtime Collaboration Refine & Test the process Develop a finished model of care
- 35. Protocol V40
- 43. ! Equipment to bring! • E-CPR trolley! • (CHEER trial only – bring 4L of cold saline)! ! Role! • Handover Team Leader role! • Allocate roles (with Team Leader)! • Cannulation! ! ! ! ! ! ! ! ! ! ! ! ! ! C2 Cannulator 1 Trolley C1 Team Leader U/S Procedure! 1. Open Cannulator 1 Box contents! 2. Open Defries pack ! 3. Scrub! 4. Sterilise groin & drape! 5. Apply ultrasound sleeve! 6. Cannulation! • Right access, Left return! ! Equipment to bring! • U/S machine! ! Role! • Assist Cannulator 1! ! ! ! ! ! ! ! ! ! ! ! ! ! C1 Cannulator 2 Trolley C2 Team Leader U/S Procedure! 1. Open Cannulator 2 Box contents (open Blue Box inside first)! 2. Pour Betadine into green bowl! 3. Pour 1L saline and 10,000 unit heparin into blue bowl! 4. Open 15F arterial, 19F Multi-stage venous cannulae! 5. Scrub! ! Role! • Confirm guidewire placement! ! ! C1 Sonographer Trolley U/S Team Leader C2 Procedure! 1. Prepare ultrasound machine ! 2. Assist in applying ultrasound sleeve! 3. Confirm guidewire position! • IVC for access! • Aorta for return CHEER trial only: ! • bolus 40mL/kg ice-saline iv ! Equipment to bring! • ECMO console! ! Role! • Prepare ECMO circuit! • No heater, no albumin for E-CPR ! ! C2 Console Person Trolley C1 Team Leader ECMO Console Console! Person U/SProcedure! Prepare primed circuit! 1. Turn console on! 2. RPM to 0! 3. Unscrew yellow cap from oxygenator ! 4. Unclamp blue & red tubes! 5. Run 2000 RPM for 2min (ensure flow in priming bag)! 6. Reapply yellow cap! 7. Clamp circuit (both blue & red tubes close to de-airing bag)! 8. RPM to 0, ECMO safety clamp on! 9. Apply white U/S cream! 10.Zero flow on console! 11. Connect oxygen to O2 cylinder (not blender) at 3L/min! 12.Await for transfer to bedside! 13.Ask C1 or C2 to check no air in circuit ! Role! • Documentation and timing! ! C1 Scribe Trolley Team Leader C2 U/S Scribe Procedure! • Time cycle! • Important times to document ! 1. CPR start! 2. Decision for ECPR! 3. Equipment arrival! 4. Skin preparation! 5. On support
- 50. #Resuswanker
- 53. The CHEER Trial
- 54. In patients with refractory cardiac arrest, does the CHEER protocol improve survival with good neurologic recovery?
- 55. 54% SURVIVAL
- 56. 36% SURVIVAL
- 58. 54% SURVIVAL
- 59. CHEER Trial - 54% Survival 26 Patients (11 OHCA 15 IHCA) 24 Patients established on ECMO (92%) Median Time 20 mins (IQR 15-30) Median Duration 2 days (IQR 1- 5) 13/24 Patients Successfully weaned from ECMO (54%) 14 Patients discharged home with full recovery (54% survival)