making ecpr happen

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Post on 14-Feb-2017

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  • Cue Audio

  • Vessel Cannulation

  • Dilatation

  • Cannulation

  • 4501

    12 july 14

    Cannula Positioning

  • Preparing Circuit

  • Connection with underwater seal

  • Establishing ECMO

  • E-CPR: Making it happen

    Jason McClure

  • The Alfred ICU

  • ECMO ECMO CPR

  • Issues with ECPRTime critical & stressful

    Infrequent

    Highly technical

    Large Number of Staff

    24/7

  • CPR to ED (Autopulse)HypothermiaECPREmergencyReperfusion

  • Developing A Protocol

  • Our MethodIdentify Problems in Realtime

    Collaboration

    Refine & Test the process

    Develop a finished model of care

  • Protocol V40

  • Areas developed

    Equipment Roles Tasks

  • Airway DoctorAirway Nurse

    Chest Compressions!

    !(Autopulse)

    Defibrillation!!

    (Autopulse)

    Drugs

  • !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

  • #Resuswanker

  • The CHEER Trial

  • In patients with refractory cardiac arrest,

    does the CHEER protocol improve survival with good neurologic

    recovery?

  • 54% SURVIVAL

  • 36% SURVIVAL

  • 54% SURVIVAL

  • CHEER Trial - 54% Survival26 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)