Hey guys we're about eight minutes in can we get a rhythm check?
>>Still in v-fib. >>Alright let's go ahead and shock.
>>Everybody clear? >>Clear. >> Shocking. Shock Delivered. >> Continue compressions.
Rebecca are you okay on the chest? >> I'm good.
>>Our main indication for ECMO is severe cardiogenic shock and severe respiratory
failure. Not responding to standard medical management but also patients on
the resuscitation when rusk is not a achieved within 10 minutes. >>Okay
guys we're in about the ten minute mark, we've given four defibrillations and
three doses of Eppi. Does anybody else have any suggestions on how to
proceed at this point? >>Maybe we should call ECMO Alert? >>ECMO alert. Everyone agree?
Okay, I will call the 8's and call an ECMO Alert. Hey this is Katey, calling from the ED.
>> The way here in Hershey to call ECMO is
you call 8-8-8-8 and you get connected through the operator. And
you tell the operator that you want to call an ECMO alert and the operator then
sends out the page that contains the location of the patient and the ECMO
team can go to this location.
The patient is normally in critical condition and
there's not a lot of time for decision-making.
The term ECMO stands for extracorporeal membrane oxygenation. And that term
actually originates from the early days of ECMO where ECMO was mainly used to
support patients in respiratory failure.
>> Hi guys, were the ECMO team, What's going on?
>>We have a 55 year old male that came in with complains of chest pain. He b-fib
arrested... >> Most important information for us is information about the patient's
medical condition, the length of resuscitation and about the patient
social situation. Would the patient that? Those extreme measures or is there
any order the technician has specifically stated he would not like to
be on life support? The majority of patients when ECMO alert is called under
emergency conditions, they will die if we would not support them.
>> Still no pulse. >>Continue compressions.
>>When you call an ECMO alert then you can expect it within
a couple of minutes. We will bring the ECMO circuit as well as what we call the
ECMO cart. That's a cart with a bunch of drawers where we do have all the
equipment stored on so we have everything that we need at the side.
Typically there's an ECMO attending, most of the time, maybe two ECMO attending, a
nurse practitioner from the intensive care unit and two nurses from the HVICCU
who were bringing all the stuff and helping set up the patient and
oftentimes also a perfusionist. The ECMO device itself is comprised of
tubing a pump had an oxygenator and is typically connected to the patient via
his groin vessels, venus and femoral vessels. And the ECMO device is able to
support the patient's cardiac as well as respiratory function.
There are quite a few centers in Pennsylvania around us who can put
patients on ECMO but it's not only the procedure that's important it's also
what comes after the procedure. So the management of the patient who is put on
ECMO that is very important and that needs a lot of manpower and a lot of
experience. Often times, it goes into a heart transplant, sometimes it goes into
lung transplant, sometimes it goes into implant of assist devices. And even though
smaller institutions may have the technology, they will not be able to do
all the management afterwards.
[distant ED dialogue]
[Distant ED Dialogue] and we have 4.9 liters of flow at 2200. >> Go ahead and stop the compressions.
Let's get a set of vital signs. >> We have a 79% we have good ejection on the monitor
I'm increasing the RPMs or at 2800 and we have a flow of six and a half.
>> Let's go ahead and package the patient up and get him down the HVI unit.