ECMO for PCI
Started by dhb
Personally, I have not. But these guys have
http://www.onlinejacc.org/content/70/9/1109?sso=1&sso_redirect_count=1&access_token=
http://www.onlinejacc.org/content/70/9/1109?sso=1&sso_redirect_count=1&access_token=
Impella yes but ecmo no. That's pretty spicy.
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+1, if you are going all the way to ECMO why not just take it a step farther and do a CABG?
Because it was a 71 y/o cripple (anoxic brain injury at birth) 3 weeks post op from a total cystectomy for a "neurological bladder" ( don't know if you use that term) that developed a respiratory sepsis post op and don't ask me why they did a coronagraphy and found a left main disease which they wanted to treat even though the dude wasn't going to do much in the excercise department...
Needless to say this case baffled me and i was super pumped about doing it
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Sounds like taxpayer money well spent.
You read my mind
Because it was a 71 y/o cripple (anoxic brain injury at birth) 3 weeks post op from a total cystectomy for a "neurological bladder" ( don't know if you use that term) that developed a respiratory sepsis post op and don't ask me why they did a coronagraphy and found a left main disease which they wanted to treat even though the dude wasn't going to do much in the excercise department...
Needless to say this case baffled me and i was super pumped about doing it
Neurogenic bladder
This person made it to 71 with anoxic brain injury at birth? And someone wanted to do ECMO on them? And to think we're taught this sort of thing only happens in the US.
I am shocked by that case, what was is his mental state? Was ethics involved? I can't even focus on the ECMO PCI portion of this case.
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I haven't.
But these guys have plenty: ED ECMO - Resuscitationist-Initiated Extracorporeal Life Support
...but not in a case like that just presented.
HH
Well this just goes to show you that futile care is not just a US thing: plenty of that in Europe too.
Normal mental status.
The case was apparently discused in the heart meeting with surgeon intensivists and cardio.
Normal mental status.
The case was apparently discused in the heart meeting with surgeon intensivists and cardio.
2016 ECMO CPT Codes, RVUs, and MediCare Reimbursement - ED ECMO
I knew this was true but wasnt aware to the degree. Just starting someone on ECMO is 22.5 wRVU. no wonder the surgeons dont want to give this over to anyone else.
I knew this was true but wasnt aware to the degree. Just starting someone on ECMO is 22.5 wRVU. no wonder the surgeons dont want to give this over to anyone else.
I thought you were in Europe.Because it was a 71 y/o cripple (anoxic brain injury at birth) 3 weeks post op from a total cystectomy for a "neurological bladder" ( don't know if you use that term) that developed a respiratory sepsis post op and don't ask me why they did a coronagraphy and found a left main disease which they wanted to treat even though the dude wasn't going to do much in the excercise department...
Needless to say this case baffled me and i was super pumped about doing it
Ok, I see that you are. Thought cases like these didn’t happen there.
Never mind.
Never mind.
Yeah it's funny how each side of the Atlantic tries to make arguments based on the percieved care given on the other side when in reality we aren't that different.
Our SS is as bankrupt as yours...
Anybody else has a take on this procedure? (not the case).
From the narrow minded POV of can I fix the heart with this management style, then yeah, I can see how the surgeons/cardiologist might say it's indicated. In my institution, we'd place a IABP instead, and only if the patient's functional status is great, and family insists. Don't have much experience with ECMO for PCI... But I suppose if you're planning to place one in for the resp. failure anyway, then doing a VVA ECMO would not be a big step away.
There's enough relative contraindications against ECMO in this patient that it sounds like a bad idea. Are you in a setting that's trying to promote more ECMO use/investigations?
There's enough relative contraindications against ECMO in this patient that it sounds like a bad idea. Are you in a setting that's trying to promote more ECMO use/investigations?
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No i'm just seeing intensivist left and right placing them as often as possible. Can't tell if it's for the sake of doing "cool" procedures, reembursement or both
Playing the devil's advocate here: ECMO does have great potential, but only if we can somehow make it cheaper and as safe/prevalent as, say, hemodialysis. One way of achieving this goal is simply by doing more of it, getting more data, and increase the demand for it. This semi investigative aspect of ECMO use may be reasonable in some institutions.
