Lesson Plan – ECMO in the ED

Picture the scene…

A patient in Resus who has been diagnosed with pandemic influenza attended the ED acutely short of breath. They have been intubated and cannot get their oxygen saturations about 60% on an FiO2 of 100% and you wonder if ECMO would be any use…

Learning Objective

To learn about the use of ECMO in the Emergency Department.

Read this blogpost​1​ from EMRA about the use of ECMO in the ED. Remember that this is a US website, but gives a good background to the history, mechanics and common indications for ECMO.

Listen to Rob Orman and Scott Weingart discuss ECMO in more detail on this ERLite podcast​2​.

During this section the facilitator should lead a discussion about the indications for ECMO and how you would make this work in your ED. For many this may be the use of cardiac bypass to then bridge the patient to get to an ECMO centre. Talk about the logistics of how you would make this happen – who would you call? Is that the same 24/7? Which patients are suitable? Have you been in a situation where cardiac bypass +/- ECMO might have helped your patient?

Although a rare intervention in the ED understanding the indications and physiology of ECMO is an interesting extension to Emergency Physician knowledge and may well become more commonplace over the next few years.

In order to embed today’s learning further, reflect on what you have learnt and record in your portfolio whether it has had any impact (or is expected to have any impact) on your performance and practice.

Was this a topic that you were confident you knew already? Which parts were new to you? Were there elements that you will use on your next clinical shift.

Dscuss this session with your colleagues – were there people who missed it who you can share the highlights with?

References and Further Reading

  1. 1
    Ghobrial M, Nugent K. A Review of ECMO in the ED: History, Mechanics, Common Indications, and Future Implications. EMRA. 2019; published online Dec 8. https://www.emra.org/emresident/article/ecmo-in-the-ed/ (accessed June 9, 2020).
  2. 2
    Orman R. What ECMO Does and Doesn’t Do. ERCast Lite. 2020; published online June 8. https://ercast.libsyn.com/what-ecmo-does-and-doesnt-do-ercast-lite-final-episode (accessed June 9, 2020).

Cite this article as: Iain Beardsell, "Lesson Plan – ECMO in the ED," in St.Emlyn's, June 9, 2020, https://www.stemlynsblog.org/lesson-plan-ecmo-in-the-ed/.

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