Weitere ähnliche Inhalte Ähnlich wie Making ECPR Happen (13) Mehr von SMACC Conference (20) Kürzlich hochgeladen (20) Making ECPR Happen29. CPR to ED (Autopulse)
Hypothermia
ECPR
Emergency
Reperfusion
43. !
Equipment to bring!
• E-CPR trolley!
• (CHEER trial only – bring 4L of cold saline)!
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Role!
• Handover Team Leader role!
• Allocate roles (with Team Leader)!
• Cannulation!
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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!
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Equipment to bring!
• U/S machine!
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Role!
• Assist Cannulator 1!
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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!
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Role!
• Confirm guidewire placement!
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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
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Equipment to bring!
• ECMO console!
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Role!
• Prepare ECMO circuit!
• No heater, no albumin for E-CPR !
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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
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Role!
• Documentation and timing!
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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
54. In patients with
refractory cardiac arrest,
does the CHEER protocol improve
survival with good neurologic
recovery?
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)