Background: Despite medical advances, survival after out of hospital cardiac arrest (OHCA) is still largely dependent on high-quality CPR. Many of these events are due to a primary cardiac event, likely coronary artery occlusion. Current guidelines recommend reperfusion therapy following cardiac arrest with signs of acute coronary occlusion on EKG. But this only applies when return of spontaneous circulation (ROSC) is achieved. What about those in refractory arrest? Is there a way to increase survival in those patients? Keeping in mind that achieving ROSC may be impossible without reperfusion and reperfusion will likely not occur without ROSC....Read More
Background: In the US out-of-hospital cardiac arrest (OHCA) has an estimated survival rate of <10% overall, but slightly better survival rates with shockable rhythms of approximately 30% . A small proportion of these patients will have refractory VF/VT OHCA not treatable by standard ACLS guidelines. One possible modality for these patients is extracorporeal membrane oxygenation (ECMO, followed by immediate coronary angiography and percutaneous coronary intervention (PCI). How would this ECMO-facilitated resuscitation strategy fair when applied in a US metropolitan community?...Read More
I am fortunate to work in a hospital system that is very forward thinking. We have a phenomenal relationship with our intensivists, and I have been fortunate enough to have several discussions with them about how we are managing COVID-19 in our ICUs. For full transparency, I don’t work up in the ICU, but had the opportunity to discuss what we are doing in our ICUs with one of our intensivists (ECMO, steroids, Remdesivir, etc...). We are doing something different in San Antonio that I thought was worth discussing on this podcast that may be a feasible option for some institutions and some patients, but not all. If there is one thing this disease has taught me, that is one size does not fit all.