# Extracorporeal Life Support (ECMO and ECPR) — GCMD Library living collection

Updated: n/a · 3 episodes · 19 cited statements

## Episodes
### ECPR Fundamentals
- [ECPR patient selection: identifying candidates for extracorporeal cardiopulmonary resuscitation](https://library.globalcastmd.com/watch/ecpr-patient-selection-identifying-candidates-for-extracorporeal-cardiopulmonary-16829) — podcast · 3:13 · [machine version](https://library.globalcastmd.com/watch/ecpr-patient-selection-identifying-candidates-for-extracorporeal-cardiopulmonary-16829.md)
- [Preparing for successful ECPR: team coordination and early activation strategies](https://library.globalcastmd.com/watch/preparing-for-successful-ecpr-team-coordination-and-early-activation-strategies-16828) — podcast · 2:13 · [machine version](https://library.globalcastmd.com/watch/preparing-for-successful-ecpr-team-coordination-and-early-activation-strategies-16828.md)

### Cannulation Techniques
- [ECMO cannulation site selection in pediatric ECPR: neck versus femoral approach](https://library.globalcastmd.com/watch/ecmo-cannulation-site-selection-in-pediatric-ecpr-neck-versus-femoral-approach-16827) — podcast · 2:46 · [machine version](https://library.globalcastmd.com/watch/ecmo-cannulation-site-selection-in-pediatric-ecpr-neck-versus-femoral-approach-16827.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/ecmo-cannulation-site-selection-in-pediatric-ecpr-neck-versus-femoral-approach-16827?t=0) Introduction and regional practice variation (Ep 3)
- [0:44](https://library.globalcastmd.com/watch/ecmo-cannulation-site-selection-in-pediatric-ecpr-neck-versus-femoral-approach-16827?t=44) Femoral versus neck cannulation considerations (Ep 3)
- [1:30](https://library.globalcastmd.com/watch/ecmo-cannulation-site-selection-in-pediatric-ecpr-neck-versus-femoral-approach-16827?t=90) Post-decannulation management and long-term surveillance (Ep 3)
- [2:08](https://library.globalcastmd.com/watch/ecmo-cannulation-site-selection-in-pediatric-ecpr-neck-versus-femoral-approach-16827?t=128) Summary and key success factors (Ep 3)
- [0:00](https://library.globalcastmd.com/watch/preparing-for-successful-ecpr-team-coordination-and-early-activation-strategies-16828?t=0) Introduction to ECPR preparation (Ep 2)
- [0:28](https://library.globalcastmd.com/watch/preparing-for-successful-ecpr-team-coordination-and-early-activation-strategies-16828?t=28) Team preparation and daily candidacy assessment (Ep 2)
- [0:49](https://library.globalcastmd.com/watch/preparing-for-successful-ecpr-team-coordination-and-early-activation-strategies-16828?t=49) Early activation protocols (Ep 2)
- [1:07](https://library.globalcastmd.com/watch/preparing-for-successful-ecpr-team-coordination-and-early-activation-strategies-16828?t=67) CPR quality monitoring during cannulation (Ep 2)
- [1:34](https://library.globalcastmd.com/watch/preparing-for-successful-ecpr-team-coordination-and-early-activation-strategies-16828?t=94) Dual attending surgeon approach (Ep 2)
- [1:54](https://library.globalcastmd.com/watch/preparing-for-successful-ecpr-team-coordination-and-early-activation-strategies-16828?t=114) Summary and conclusion (Ep 2)
- [0:01](https://library.globalcastmd.com/watch/ecpr-patient-selection-identifying-candidates-for-extracorporeal-cardiopulmonary-16829?t=1) Introduction to ECPR and defining success (Ep 1)
- [1:01](https://library.globalcastmd.com/watch/ecpr-patient-selection-identifying-candidates-for-extracorporeal-cardiopulmonary-16829?t=61) Patient selection considerations and reversible pathology (Ep 1)
- [1:59](https://library.globalcastmd.com/watch/ecpr-patient-selection-identifying-candidates-for-extracorporeal-cardiopulmonary-16829?t=119) Clinical indicators and laboratory data in decision-making (Ep 1)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- Simulation has been shown to have better outcomes, at least in terms of team dynamics and patient selection. — Juan Gurria (clinical) [Ep 2 · 0:30](https://library.globalcastmd.com/watch/preparing-for-successful-ecpr-team-coordination-and-early-activation-strategies-16828?t=30)
- ICU teams need to think every day about ECLS candidacy both electively and in the crunch. — Juan Gurria (clinical) [Ep 2 · 0:36](https://library.globalcastmd.com/watch/preparing-for-successful-ecpr-team-coordination-and-early-activation-strategies-16828?t=36)
- At Cincinnati Children's Hospital, after the second dose of epinephrine during cardiac arrest, they activate ECPR and all teams mobilize. — David Rothstein (clinical) [Ep 2 · 0:52](https://library.globalcastmd.com/watch/preparing-for-successful-ecpr-team-coordination-and-early-activation-strategies-16828?t=52)
- CPR coaches are key, showing cardiac output through title CO2, oxygenation, and cardiac index from compressions. — David Rothstein (clinical) [Ep 2 · 1:15](https://library.globalcastmd.com/watch/preparing-for-successful-ecpr-team-coordination-and-early-activation-strategies-16828?t=75)
- Two attending surgeons is key for ECPR and is practiced at Cincinnati Children's. — David Rothstein (clinical) [Ep 2 · 1:34](https://library.globalcastmd.com/watch/preparing-for-successful-ecpr-team-coordination-and-early-activation-strategies-16828?t=94)
- During ECPR it is chaotic with people running around and pushing from behind, and you need to pause compressions to cannulate. — David Rothstein (clinical) [Ep 2 · 1:38](https://library.globalcastmd.com/watch/preparing-for-successful-ecpr-team-coordination-and-early-activation-strategies-16828?t=98)
- ECPR is extracorporeal cardiopulmonary resuscitation, which involves adding ECMO or extracorporeal life support membrane oxygenation to conventional CPR to increase outcomes. — Juan Gurria (clinical) [Ep 1 · 0:31](https://library.globalcastmd.com/watch/ecpr-patient-selection-identifying-candidates-for-extracorporeal-cardiopulmonary-16829?t=31)
- Success in ECPR can be defined as survival with a favorable neurologic outcome. — Juan Gurria (clinical) [Ep 1 · 0:56](https://library.globalcastmd.com/watch/ecpr-patient-selection-identifying-candidates-for-extracorporeal-cardiopulmonary-16829?t=56)
- ECPR candidates need to have reversible pathology because ECMO is not a destination but a bridge to try to gain more time. — David Rothstein (clinical) [Ep 1 · 1:42](https://library.globalcastmd.com/watch/ecpr-patient-selection-identifying-candidates-for-extracorporeal-cardiopulmonary-16829?t=102)
- Not all out of hospital arrests are the same; some patients may have a dismal presentation but reasonable numbers reflecting some sort of circulation, while others may have great community response but terrible numbers. — Juan Gurria (clinical) [Ep 1 · 2:08](https://library.globalcastmd.com/watch/ecpr-patient-selection-identifying-candidates-for-extracorporeal-cardiopulmonary-16829?t=128)
- Great laboratory numbers may be more important than CPR downtime in determining ECPR candidacy. — Juan Gurria (opinion) [Ep 1 · 2:33](https://library.globalcastmd.com/watch/ecpr-patient-selection-identifying-candidates-for-extracorporeal-cardiopulmonary-16829?t=153)
- In Seattle, femoral cannulation is preferred because it stays out of the way of CPR — Juan Gurria (clinical) [Ep 3 · 0:44](https://library.globalcastmd.com/watch/ecmo-cannulation-site-selection-in-pediatric-ecpr-neck-versus-femoral-approach-16827?t=44)
- Femoral cannulation works better in bigger kids due to vessel size — Juan Gurria (clinical) [Ep 3 · 0:48](https://library.globalcastmd.com/watch/ecmo-cannulation-site-selection-in-pediatric-ecpr-neck-versus-femoral-approach-16827?t=48)
- Femoral cannulation carries risk of femoral vessel injury and limb loss — Juan Gurria (clinical) [Ep 3 · 0:48](https://library.globalcastmd.com/watch/ecmo-cannulation-site-selection-in-pediatric-ecpr-neck-versus-femoral-approach-16827?t=48)
- One institution does neck cannulation almost exclusively — Juan Gurria (clinical) [Ep 3 · 0:55](https://library.globalcastmd.com/watch/ecmo-cannulation-site-selection-in-pediatric-ecpr-neck-versus-femoral-approach-16827?t=55)
- Stroke rate with neck cannulation is up to 10% on current data — David Rothstein (epidemiological) [Ep 3 · 1:26](https://library.globalcastmd.com/watch/ecmo-cannulation-site-selection-in-pediatric-ecpr-neck-versus-femoral-approach-16827?t=86)
- There is debate over ligation versus reconstruction with pros and cons to both approaches — Juan Gurria (opinion) [Ep 3 · 1:48](https://library.globalcastmd.com/watch/ecmo-cannulation-site-selection-in-pediatric-ecpr-neck-versus-femoral-approach-16827?t=108)
- At Seattle Children's, narrowing of different percentages has been found even with ligation, including intimal flaps — Juan Gurria (clinical) [Ep 3 · 1:51](https://library.globalcastmd.com/watch/ecmo-cannulation-site-selection-in-pediatric-ecpr-neck-versus-femoral-approach-16827?t=111)
- Long-term vascular surveillance is recommended rather than a one-time assessment — Juan Gurria (opinion) [Ep 3 · 2:06](https://library.globalcastmd.com/watch/ecmo-cannulation-site-selection-in-pediatric-ecpr-neck-versus-femoral-approach-16827?t=126)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- The most important part of a successful ECPR case often happens before the patient ever arrests. — Lizzy Lee summarizing the discussion [Ep 2 · 0:08](https://library.globalcastmd.com/watch/preparing-for-successful-ecpr-team-coordination-and-early-activation-strategies-16828?t=8)
- ECPR requires a multidisciplinary team of surgeons, intensivists, perfusionists, nurses, respiratory therapists, and pharmacists. — Lizzy Lee summarizing the discussion [Ep 2 · 0:41](https://library.globalcastmd.com/watch/preparing-for-successful-ecpr-team-coordination-and-early-activation-strategies-16828?t=41)
- Experienced centers often activate the ECMO team early rather than waiting until everyone agrees that the arrest is not reversible. — Lizzy Lee summarizing the discussion [Ep 2 · 0:59](https://library.globalcastmd.com/watch/preparing-for-successful-ecpr-team-coordination-and-early-activation-strategies-16828?t=59)
- One challenge during cannulation is avoiding interruptions in chest compressions. — Lizzy Lee summarizing the discussion [Ep 2 · 1:07](https://library.globalcastmd.com/watch/preparing-for-successful-ecpr-team-coordination-and-early-activation-strategies-16828?t=67)
- Every unnecessary pause in chest compressions can reduce coronary and cerebral perfusion. — Lizzy Lee summarizing the discussion [Ep 2 · 1:11](https://library.globalcastmd.com/watch/preparing-for-successful-ecpr-team-coordination-and-early-activation-strategies-16828?t=71)
- High performing ECPR teams continuously measure CPR quality and adjust in real time using physiologic feedback. — Lizzy Lee summarizing the discussion [Ep 2 · 1:25](https://library.globalcastmd.com/watch/preparing-for-successful-ecpr-team-coordination-and-early-activation-strategies-16828?t=85)
- Having two attending surgeons minimizes pauses during compressions because the second attending can check the circuit and ensure the right cannula is used. — Lizzy Lee summarizing the discussion [Ep 2 · 1:46](https://library.globalcastmd.com/watch/preparing-for-successful-ecpr-team-coordination-and-early-activation-strategies-16828?t=106)
- To improve outcomes from ECPR, it is important to prepare before cardiac arrest, practice simulations, activate ECPR early, and measure CPR performance in real time. — Lizzy Lee summarizing the discussion [Ep 2 · 1:54](https://library.globalcastmd.com/watch/preparing-for-successful-ecpr-team-coordination-and-early-activation-strategies-16828?t=114)
- ECPR doesn't replace conventional CPR; it adds temporary heart and lung support while clinicians work to treat a potentially reversible cause of arrest. — Lizzy Lee summarizing the discussion [Ep 1 · 0:45](https://library.globalcastmd.com/watch/ecpr-patient-selection-identifying-candidates-for-extracorporeal-cardiopulmonary-16829?t=45)
- Considerations when deciding if a patient should receive ECPR include the likelihood that they will recover, whether the underlying disease can actually be treated, equitable use of resources, and long-term follow-up. — Lizzy Lee summarizing the discussion [Ep 1 · 1:04](https://library.globalcastmd.com/watch/ecpr-patient-selection-identifying-candidates-for-extracorporeal-cardiopulmonary-16829?t=64)
- A child who has had CPR for 30 minutes is not automatically a poor ECPR candidate. — Lizzy Lee summarizing the discussion [Ep 1 · 1:35](https://library.globalcastmd.com/watch/ecpr-patient-selection-identifying-candidates-for-extracorporeal-cardiopulmonary-16829?t=95)
- ECPR is reserved for patients who still have a realistic chance of recovery if ECMO can buy enough time, not simply for the sickest patient. — Lizzy Lee summarizing the discussion [Ep 1 · 1:49](https://library.globalcastmd.com/watch/ecpr-patient-selection-identifying-candidates-for-extracorporeal-cardiopulmonary-16829?t=109)
- ECPR candidates have had a witnessed arrest, evidence that organs are still being perfused, and a chance that the underlying disease can be fixed. — Lizzy Lee summarizing the discussion [Ep 1 · 1:59](https://library.globalcastmd.com/watch/ecpr-patient-selection-identifying-candidates-for-extracorporeal-cardiopulmonary-16829?t=119)
- Laboratory data such as pH, potassium, and evidence of circulation provide valuable context and influence decision making just as much as the duration of CPR. — Lizzy Lee summarizing the discussion [Ep 1 · 2:21](https://library.globalcastmd.com/watch/ecpr-patient-selection-identifying-candidates-for-extracorporeal-cardiopulmonary-16829?t=141)
- Choosing the right ECPR patient isn't about following one laboratory value or one time limit; reversible disease matters the most. — Lizzy Lee summarizing the discussion [Ep 1 · 2:46](https://library.globalcastmd.com/watch/ecpr-patient-selection-identifying-candidates-for-extracorporeal-cardiopulmonary-16829?t=166)
- It's important to combine physiology, clinical judgment, and preparation to identify the patients most likely to benefit from ECPR. — Lizzy Lee summarizing the discussion [Ep 1 · 2:54](https://library.globalcastmd.com/watch/ecpr-patient-selection-identifying-candidates-for-extracorporeal-cardiopulmonary-16829?t=174)
- There is no universally superior cannulation approach for pediatric ECPR — Lizzy Lee summarizing the discussion [Ep 3 · 0:35](https://library.globalcastmd.com/watch/ecmo-cannulation-site-selection-in-pediatric-ecpr-neck-versus-femoral-approach-16827?t=35)
- The optimal cannulation site depends on the patient's size, anatomy, clinical condition, and the expertise of the ECMO team — Lizzy Lee summarizing the discussion [Ep 3 · 0:37](https://library.globalcastmd.com/watch/ecmo-cannulation-site-selection-in-pediatric-ecpr-neck-versus-femoral-approach-16827?t=37)
- Femoral cannulation can make ongoing resuscitation easier, particularly in adolescents — Lizzy Lee summarizing the discussion [Ep 3 · 1:00](https://library.globalcastmd.com/watch/ecmo-cannulation-site-selection-in-pediatric-ecpr-neck-versus-femoral-approach-16827?t=60)
- With femoral cannulation, it is important to protect limb perfusion and maintain blood flow to the leg — Lizzy Lee summarizing the discussion [Ep 3 · 1:06](https://library.globalcastmd.com/watch/ecmo-cannulation-site-selection-in-pediatric-ecpr-neck-versus-femoral-approach-16827?t=66)
- In younger children, neck cannulation often provides better vessel size and more reliable flow — Lizzy Lee summarizing the discussion [Ep 3 · 1:13](https://library.globalcastmd.com/watch/ecmo-cannulation-site-selection-in-pediatric-ecpr-neck-versus-femoral-approach-16827?t=73)
- Neck cannulation carries concern about neurologic complications, although newer evidence suggests the stroke risk may be lower than previously believed — Lizzy Lee summarizing the discussion [Ep 3 · 1:19](https://library.globalcastmd.com/watch/ecmo-cannulation-site-selection-in-pediatric-ecpr-neck-versus-femoral-approach-16827?t=79)
- Neither femoral nor neck cannulation approach is risk-free — Lizzy Lee summarizing the discussion [Ep 3 · 1:30](https://library.globalcastmd.com/watch/ecmo-cannulation-site-selection-in-pediatric-ecpr-neck-versus-femoral-approach-16827?t=90)
- After decannulation from ECMO, the vessel can either be ligated (permanently tied off) or reconstructed (surgically repaired) — Lizzy Lee summarizing the discussion [Ep 3 · 1:39](https://library.globalcastmd.com/watch/ecmo-cannulation-site-selection-in-pediatric-ecpr-neck-versus-femoral-approach-16827?t=99)
- 54% in the carotid group have significant vascular changes such as occlusion, stenosis, and intimal changes — Lizzy Lee summarizing the discussion [Ep 3 · 1:59](https://library.globalcastmd.com/watch/ecmo-cannulation-site-selection-in-pediatric-ecpr-neck-versus-femoral-approach-16827?t=119)
- The literature does not support a single best cannulation site for every patient — Lizzy Lee summarizing the discussion [Ep 3 · 2:09](https://library.globalcastmd.com/watch/ecmo-cannulation-site-selection-in-pediatric-ecpr-neck-versus-femoral-approach-16827?t=129)
- Key considerations for cannulation site selection include patient size, anatomy, clinical condition, and risk — Lizzy Lee summarizing the discussion [Ep 3 · 2:14](https://library.globalcastmd.com/watch/ecmo-cannulation-site-selection-in-pediatric-ecpr-neck-versus-femoral-approach-16827?t=134)
- The femoral approach has easier access but requires monitoring of limb perfusion — Lizzy Lee summarizing the discussion [Ep 3 · 2:19](https://library.globalcastmd.com/watch/ecmo-cannulation-site-selection-in-pediatric-ecpr-neck-versus-femoral-approach-16827?t=139)
- The neck approach is better in smaller children but requires consideration of neurologic risk — Lizzy Lee summarizing the discussion [Ep 3 · 2:24](https://library.globalcastmd.com/watch/ecmo-cannulation-site-selection-in-pediatric-ecpr-neck-versus-femoral-approach-16827?t=144)
- Success is consistently predicted by having an experienced team that can establish ECMO rapidly and safely using the technique they know best — Lizzy Lee summarizing the discussion [Ep 3 · 2:29](https://library.globalcastmd.com/watch/ecmo-cannulation-site-selection-in-pediatric-ecpr-neck-versus-femoral-approach-16827?t=149)

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