Ron Herschel

21 statements · 1 topic · summaries given as host listed separately

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sit on your hands, don't put lines, don't put chest tubes unless you have to. If they're physiologically compromised or you really think that it's, it's compromising their gas exchange, uh, or their ability to come off ECMO and so on, fine. But we've had plenty of chest tubes we placed. You put a chest tube in, I would say about half the time, you're going to end up doing a thoracotomy because of bleeding.
quote · Extracorporeal Membrane Oxygenation
VV is, is markedly preferred. The, the best approach is to go VV unless you have specific reasons why you. Need to go VA.
quote · Extracorporeal Membrane Oxygenation

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Ron's statements about Extracorporeal Membrane Oxygenation 21 statements

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Update Course Rewind: ECMO 2018

Statement VA ECMO offloads the right heart and increases afterload of the left heart with no recirculation Open
Statement VV ECMO provides normal left ventricular afterload and reduced risk for systemic emboli compared to VA ECMO Open
Quotation VV is, is markedly preferred. The, the best approach is to go VV unless you have specific reasons why you. Need to go VA. Open
Statement VV ECMO is markedly preferred over VA ECMO unless there are specific reasons requiring VA support Open
Quotation the stroke rate is about 5%. Um, if you cannulate the carotid, but look, the stroke rate, if you don't cannulate the carotid, is only about 1% less. Oh, so maybe it's not necessarily about where you cannulate, but the fact that these patients are just very sick and they have high stroke rates. Open
Statement High stroke rates in ECMO patients may be related to patient illness severity rather than specifically to carotid cannulation Open
Statement In critically ill patients requiring ECMO, it is more important to achieve rapid cannulation and stabilization than to avoid carotid access Open
Quotation you have someone who's really sick, OK? Don't mess around. Because you can sit there messing around trying to knock can at the carotid when, when the best thing for them is to get on VA bypass and get them stabilized. Open
Statement At University of Michigan, for VA ECMO in children less than 35 kg, carotid-IJ cannulation is used Open
Statement For patients over 35 kg requiring VA ECMO, femoral cannulation or carotid-IJ may be used, though VV is still preferred when possible Open
Statement Subclavian access for ECMO is used routinely by many adult practitioners and is better tolerated than femoral access because the arm tolerates ischemia better than the leg Open
Quotation We actually, in older patients, will do um a posterior tibial artery, and we do it routinely. Open
Statement Posterior tibial artery cannulation is performed routinely in older patients at University of Michigan to prevent limb ischemia Open
Statement Alternative techniques for preventing limb ischemia include placing a side graft onto the femoral artery or using subclavian artery access Open
Statement For VV ECMO using separate femoral and IJ cannulas, the M-bridge configuration (draining from femoral, reinfusing into atrial) minimizes recirculation Open
Statement The Avalon single cannula is well tolerated and allows more patient mobility Open
Statement The Avalon catheter requires placement of the distal tip into the inferior vena cava, which is not easy and requires getting a wire into the IVC Open
Statement When chest tube placement leads to bleeding in ECMO patients, management involves packing the chest and leaving it open Open
Statement Approximately 50% of chest tubes placed in ECMO patients result in bleeding requiring thoracotomy Open
Statement Chest tubes should not be placed in ECMO patients with pneumothorax unless the patient is physiologically compromised or gas exchange is affected Open
Quotation sit on your hands, don't put lines, don't put chest tubes unless you have to. If they're physiologically compromised or you really think that it's, it's compromising their gas exchange, uh, or their ability to come off ECMO and so on, fine. But we've had plenty of chest tubes we placed. You put a chest tube in, I would say about half the time, you're going to end up doing a thoracotomy because of bleeding. Open

Summaries Ron gave as host · 3 summaries

Recaps of other experts' statements, not Ron's own clinical position.

Summaries Ron gave as host · Extracorporeal Membrane Oxygenation 3 summaries

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Update Course Rewind: ECMO 2018

Host summary Ron Herschel summarizing a resource: In a registry of 30,000 patients, stroke rate with carotid cannulation is about 5%, compared to about 4% without carotid cannulation Open
Host summary Ron Herschel summarizing a resource: even with a distal profusion cannula, they ended up in 9/11. 11 having ischemia. Open
Host summary Ron Herschel summarizing a resource: In a study of femoral artery cannulation in patients aged 2-22 years, 9 out of 11 patients developed limb ischemia even with distal perfusion cannula Open