ECMO truck

This was a big hot topic at eagles two years ago.

To be honest, I’m not sure how useful this is in a heavily populated area..
 
Oh yea and gimme some complications associated with field cannulation!

How about doing a study of abdominal tourniquet + LUCAS vs ECMO in prehospital environment for non-hypothermic refractory VF.

www.sciencedirect.com

A tourniquet assisted cardiopulmonary resuscitation augments myocardial perfusion in a porcine model of cardiac arrest

During cardiopulmonary resuscitation (CPR), myocardial blood flow generated by chest compression rarely exceeds 35% of its normal level. Cardiac outpu…
www.sciencedirect.com www.sciencedirect.com
 
Summit said:
Oh yea and gimme some complications associated with field cannulation!

How about doing a study of abdominal tourniquet + LUCAS vs ECMO in prehospital environment for non-hypothermic refractory VF.

www.sciencedirect.com

A tourniquet assisted cardiopulmonary resuscitation augments myocardial perfusion in a porcine model of cardiac arrest

During cardiopulmonary resuscitation (CPR), myocardial blood flow generated by chest compression rarely exceeds 35% of its normal level. Cardiac outpu…
www.sciencedirect.com www.sciencedirect.com
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Bring back MAST!!!:D I'm tellin' you...it's coming back....
 
What a waste of money.

Most studies that showed consistent benefit with ECPR had such strict inclusion criteria that they would have likely had statistically favorable outcomes versus the majority of resuscitations.

I’m a bit confused as to how this is going to work anyway. I assume this will be adult only, and I assume it will be fem-fem or fem-IJ. While most people can be cannulated this way I doubt they will be doing any axial or chest cannulations in the field, which of course further narrows the candidate pool. Who is going to prime and run pump, will they bring a perfusionist as the doc is assumably cannulating? Since it is a field response you have to bring everything with you. PRBCs, plts, FFP, cryo, bicarb, lytes, heparin, vit k, amicar, txa, and so on. How do you run coags, let alone a TEG in the back of a bus? What about a CBC? Meanwhile during all of this we still need high quality CPR and airway management.

I just think about how much more these millions of dollars could be spend in EMS, ED, or public health and improve the outcome of thousands of lives rather than a handful at most.
 
I am a huge advocate for ECMO however field ECMO is just a flex and waste of resources.

Have a robust ED ECMO program and encourage early transport with mechanical CPR for appropriate patients


Peak said:
I’m a bit confused as to how this is going to work anyway. I assume this will be adult only, and I assume it will be fem-fem or fem-IJ. While most people can be cannulated this way I doubt they will be doing any axial or chest cannulations in the field, which of course further narrows the candidate pool. Who is going to prime and run pump, will they bring a perfusionist as the doc is assumably cannulating? Since it is a field response you have to bring everything with you. PRBCs, plts, FFP, cryo, bicarb, lytes, heparin, vit k, amicar, txa, and so on. How do you run coags, let alone a TEG in the back of a bus? What about a CBC? Meanwhile during all of this we still need high quality CPR and airway management.
Click to expand...

Most intra-arrest ECPR are shotgun fem-fem VA. I am assuming they will have pre-primed circuits however most of the time with retrievals the doc does all the circuit management was well.

Yeah they won't care about labs. Slug of heparin, cannulate, and worry about it later. These are presumably all within pretty short transports to the ER.

I have even heard some of these programs don't even plan on using pump consoles but rather hand cranking centrimag or cardiohelp circuits until they arrive at the hopsital
 
This is interesting... it will (correct me if I'm wrong) take the place of the heart and lungs to keep the person alive until they get to the hospital? cool. What exactly will the hospital be doing for the patient once the ecmo team gets there?

I can't see this truck being practical; will it be dispatched to every cardiac arrest in the county? It's a huge vehicle, and I imagine it will be canceled on 90% of its calls. That's a lot of wear and tear. I am sure you can put most of the other stuff you need somewhere in it, but I'm more concerned about the manpower needed to do all of the stuff for an ecmo.

But hey, it's grant money (1.8 million isn't much when you look at the budget for a major EMS system or hospital), and it's good PR... we have wasted more grant money on less useful things before.
 
DrParasite said:
This is interesting... it will (correct me if I'm wrong) take the place of the heart and lungs to keep the person alive until they get to the hospital? cool. What exactly will the hospital be doing for the patient once the ecmo team gets there?

I can't see this truck being practical; will it be dispatched to every cardiac arrest in the county? It's a huge vehicle, and I imagine it will be canceled on 90% of its calls. That's a lot of wear and tear. I am sure you can put most of the other stuff you need somewhere in it, but I'm more concerned about the manpower needed to do all of the stuff for an ecmo.

But hey, it's grant money (1.8 million isn't much when you look at the budget for a major EMS system or hospital), and it's good PR... we have wasted more grant money on less useful things before.
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It's grant money right up until they start billing the patient for the truck use.
 
I'd also be concerned that once this truck goes into operation, crews will stay and play more on scene instead of rapidly transporting to the ER.
 
VFlutter said:
Most intra-arrest ECPR are shotgun fem-fem VA. I am assuming they will have pre-primed circuits however most of the time with retrievals the doc does all the circuit management was well.

Yeah they won't care about labs. Slug of heparin, cannulate, and worry about it later. These are presumably all within pretty short transports to the ER.

I have even heard some of these programs don't even plan on using pump consoles but rather hand cranking centrimag or cardiohelp circuits until they arrive at the hopsital
Click to expand...
Mobile point of care labs are really easy now with instruments like the iStat. Full chemistry/hematology panels in minutes. But that part is the least of the burden of maintaining capability like this. They'll have a few high profile saves, but I can't imagine the cost per life saved being sustainable.
 
What happens when the truck can’t reach the patient? Load into ambulance? Drive to truck. Unload. Upload. Drive to ER?
 
CCCSD said:
What happens when the truck can’t reach the patient? Load into ambulance? Drive to truck. Unload. Upload. Drive to ER?
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Good point...I can easily see a scenario where a BLS unit starts transport to an ALS intercept, patient is transferred and now the ALS unit calls for an ECMO intercept, resulting in a second patient transfer. Not only has time been wasted transferring the patient multiple times, the patient (or their family) just got billed for three increasingly expensive ambulance rides. Not entirely sure insurance or Medicare/Medicaid would cover that.
 
What if there are...GASP!...Two arrests on opposite sides of the city with viable candidates?

Choose wisely. The lawsuit is going to HURT!
 
We have a stroke truck around here.. Limited view CT.. can give tPA when appropriate (although they pretty much refuse to disclose how many times they've given it).

I feel the same way about the stroke truck. You can't swing a dead cat without hitting a comprehensive stroke center around here.. I kinda feel like we're just wasting time and money. I still think back to a stroke run last summer that was in a medical office outbuilding of a local hospital with a comprehensive stroke center. Rather than just driving across the parking lot, the stroke truck tied up the patient for something like 40 minutes on scene doing whatever they were doing..
 
E tank said:
Bring back MAST!!!:D I'm tellin' you...it's coming back....
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Everything old is new again!

VFlutter said:
Have a robust ED ECMO program and encourage early transport with mechanical CPR for appropriate patients
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Certainly cheaper in terms of fixed costs, I'd wager. Does ED ECMO involve meaningfully more staffing?
 
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