Mein ITW Dienst am Wochenende wird sicherlich wieder voll mit #Influenza Verlegungen ins ARDS Zentrum/zur ECMO.
Maske, Impfung, lüften, Zuhause bleiben. You know the drill.
#Notfallmedizin
Maske, Impfung, lüften, Zuhause bleiben. You know the drill.
#Notfallmedizin
Wallah habibis, dassma ne imposante Influenza-B-Welle 😵
February 14, 2025 at 4:22 PM
Mein ITW Dienst am Wochenende wird sicherlich wieder voll mit #Influenza Verlegungen ins ARDS Zentrum/zur ECMO.
Maske, Impfung, lüften, Zuhause bleiben. You know the drill.
#Notfallmedizin
Maske, Impfung, lüften, Zuhause bleiben. You know the drill.
#Notfallmedizin
New 📝
We know RV dysfunction occurs on VV-ECMO in ARDS despite ECMO mitigating many of the traditional RV dysfunction risk factors (hypercapnia etc)
We don’t understand RV function dynamically over time on ECMO…
We know RV dysfunction occurs on VV-ECMO in ARDS despite ECMO mitigating many of the traditional RV dysfunction risk factors (hypercapnia etc)
We don’t understand RV function dynamically over time on ECMO…
April 21, 2025 at 12:07 PM
New 📝
We know RV dysfunction occurs on VV-ECMO in ARDS despite ECMO mitigating many of the traditional RV dysfunction risk factors (hypercapnia etc)
We don’t understand RV function dynamically over time on ECMO…
We know RV dysfunction occurs on VV-ECMO in ARDS despite ECMO mitigating many of the traditional RV dysfunction risk factors (hypercapnia etc)
We don’t understand RV function dynamically over time on ECMO…
🚫KEINE VA-ECMO 💙❤️🩸bei therapierefraktärem septischen Schock ohne begleitenden kardiogenen Schock
❓Keine Empfehlung für oder gegen VA-ECMO bei kombiniert septisch-kardiogenem Schock
🫁Bei Sepsis und ARDS Tidalvolumen 6 ml/kg IBW (4-8ml/kg IBW) und eine inspiratorische Druckdifferenz von ≤ 14 cmH20
❓Keine Empfehlung für oder gegen VA-ECMO bei kombiniert septisch-kardiogenem Schock
🫁Bei Sepsis und ARDS Tidalvolumen 6 ml/kg IBW (4-8ml/kg IBW) und eine inspiratorische Druckdifferenz von ≤ 14 cmH20
July 27, 2025 at 8:44 PM
🚫KEINE VA-ECMO 💙❤️🩸bei therapierefraktärem septischen Schock ohne begleitenden kardiogenen Schock
❓Keine Empfehlung für oder gegen VA-ECMO bei kombiniert septisch-kardiogenem Schock
🫁Bei Sepsis und ARDS Tidalvolumen 6 ml/kg IBW (4-8ml/kg IBW) und eine inspiratorische Druckdifferenz von ≤ 14 cmH20
❓Keine Empfehlung für oder gegen VA-ECMO bei kombiniert septisch-kardiogenem Schock
🫁Bei Sepsis und ARDS Tidalvolumen 6 ml/kg IBW (4-8ml/kg IBW) und eine inspiratorische Druckdifferenz von ≤ 14 cmH20
3/n: New World hantavirus infections are rough stuff, once symptoms begin, the resulting cytokine storm and ARDS means there's not much of a window before getting them into an ICU, and often on ECMO, extracorporeal membrane oxygenation, which requires a high level of skill.
May 12, 2026 at 2:13 AM
3/n: New World hantavirus infections are rough stuff, once symptoms begin, the resulting cytokine storm and ARDS means there's not much of a window before getting them into an ICU, and often on ECMO, extracorporeal membrane oxygenation, which requires a high level of skill.
Should APRV remain part of the recommendations in severe ARDS, and should a trial be considered before VV ECMO referral?
Discuss. #emimcc
@pulmcrit.bsky.social @icmtim.bsky.social
Open DOI: our ECMO centre doesn’t recommend APRV…
Discuss. #emimcc
@pulmcrit.bsky.social @icmtim.bsky.social
Open DOI: our ECMO centre doesn’t recommend APRV…
Having spoken to them - it was recognised that cARDS didn't respond to PEEP as non-cARDS. V/Q mismatch was increasingly recognised. One size does not fit all. As with high PEEP, APRV will help some patients, not others.
ARPV regularly recommended as a trial by centres as I say.
ARPV regularly recommended as a trial by centres as I say.
June 5, 2025 at 11:53 AM
Should APRV remain part of the recommendations in severe ARDS, and should a trial be considered before VV ECMO referral?
Discuss. #emimcc
@pulmcrit.bsky.social @icmtim.bsky.social
Open DOI: our ECMO centre doesn’t recommend APRV…
Discuss. #emimcc
@pulmcrit.bsky.social @icmtim.bsky.social
Open DOI: our ECMO centre doesn’t recommend APRV…
@drfreeze.bsky.social @load-dependent.eurosky.social @thinkingcc.bsky.social
Patient on VV ECMO for ARDS. Qecmo 4 L/min. Multifactorial shock including severe burns and pneumonia. CCRT. Follow-up CT scan due to poor clinical course. Incidental finding of proximal PE straddling the bifurcation. ?
Patient on VV ECMO for ARDS. Qecmo 4 L/min. Multifactorial shock including severe burns and pneumonia. CCRT. Follow-up CT scan due to poor clinical course. Incidental finding of proximal PE straddling the bifurcation. ?
October 2, 2026 at 10:43 AM
@drfreeze.bsky.social @load-dependent.eurosky.social @thinkingcc.bsky.social
Patient on VV ECMO for ARDS. Qecmo 4 L/min. Multifactorial shock including severe burns and pneumonia. CCRT. Follow-up CT scan due to poor clinical course. Incidental finding of proximal PE straddling the bifurcation. ?
Patient on VV ECMO for ARDS. Qecmo 4 L/min. Multifactorial shock including severe burns and pneumonia. CCRT. Follow-up CT scan due to poor clinical course. Incidental finding of proximal PE straddling the bifurcation. ?
'RV dysfunction occurs on VV-ECMO in ARDS despite ECMO mitigating many of the traditional RV dysfunction risk factor'
#critcaresky #cccsky #ecmo #vv-ecmo #emimcc
#critcaresky #cccsky #ecmo #vv-ecmo #emimcc
New 📝
We know RV dysfunction occurs on VV-ECMO in ARDS despite ECMO mitigating many of the traditional RV dysfunction risk factors (hypercapnia etc)
We don’t understand RV function dynamically over time on ECMO…
We know RV dysfunction occurs on VV-ECMO in ARDS despite ECMO mitigating many of the traditional RV dysfunction risk factors (hypercapnia etc)
We don’t understand RV function dynamically over time on ECMO…
April 21, 2025 at 12:18 PM
'RV dysfunction occurs on VV-ECMO in ARDS despite ECMO mitigating many of the traditional RV dysfunction risk factor'
#critcaresky #cccsky #ecmo #vv-ecmo #emimcc
#critcaresky #cccsky #ecmo #vv-ecmo #emimcc
I think, given that it took many trials with different sample sizes and durations of proning for us to realise its effectiveness in ARDS without ECMO, it would be even harder to prove in patients on ECMO for several reasons. COI: I love to prone 🧵 #emimcc
interesting editorial on proning during VV-ECMO
the sequence of [#1] VV-ECMO without a prone trial, and then [#2] proning while on VV-ECMO seems 🍑 backwards
and proning while on VV-ECMO doesn't seem awesome (c/w the largest RCT)
(but there may be situations where this makes sense 🤷♂️) #EMIMCC
the sequence of [#1] VV-ECMO without a prone trial, and then [#2] proning while on VV-ECMO seems 🍑 backwards
and proning while on VV-ECMO doesn't seem awesome (c/w the largest RCT)
(but there may be situations where this makes sense 🤷♂️) #EMIMCC
June 9, 2025 at 9:28 AM
I think, given that it took many trials with different sample sizes and durations of proning for us to realise its effectiveness in ARDS without ECMO, it would be even harder to prove in patients on ECMO for several reasons. COI: I love to prone 🧵 #emimcc
2 recent H5N1 articles in NEJM:
One described n=49 people with mild illness, mostly conjunctivitis. Only a minority had respiratory symptoms. None hospitalized.
Another described 1 patient with severe ARDS requiring ECMO.
Overall this is worrisome. 1 in 50 people getting very sick would be a LOT.
One described n=49 people with mild illness, mostly conjunctivitis. Only a minority had respiratory symptoms. None hospitalized.
Another described 1 patient with severe ARDS requiring ECMO.
Overall this is worrisome. 1 in 50 people getting very sick would be a LOT.
January 1, 2025 at 6:17 PM
2 recent H5N1 articles in NEJM:
One described n=49 people with mild illness, mostly conjunctivitis. Only a minority had respiratory symptoms. None hospitalized.
Another described 1 patient with severe ARDS requiring ECMO.
Overall this is worrisome. 1 in 50 people getting very sick would be a LOT.
One described n=49 people with mild illness, mostly conjunctivitis. Only a minority had respiratory symptoms. None hospitalized.
Another described 1 patient with severe ARDS requiring ECMO.
Overall this is worrisome. 1 in 50 people getting very sick would be a LOT.
I wondered what happened to the kid in Canada with H5N1. I suspected she had developed ARDS. I was right. In addition, pneumonia in the left lower lobe, acute kidney injury, thrombocytopenia, and leukopenia and needed ECMO. She was previously healthy.
www.nejm.org/doi/full/10....
www.nejm.org/doi/full/10....
Critical Illness in an Adolescent with Influenza A(H5N1) Virus Infection | NEJM
Influenza A(H5N1) viruses are an emerging zoonotic threat and have spread widely throughout birds in North America. Recently, influenza A(H5N1) infection led to serious illness in a teenager in Canada.
www.nejm.org
January 1, 2025 at 5:09 AM
I wondered what happened to the kid in Canada with H5N1. I suspected she had developed ARDS. I was right. In addition, pneumonia in the left lower lobe, acute kidney injury, thrombocytopenia, and leukopenia and needed ECMO. She was previously healthy.
www.nejm.org/doi/full/10....
www.nejm.org/doi/full/10....
The Andes strain, which is what these people have, does have a mortality rate of ~40% and the cause of death is from ARDS. Ivermectin won't do shit. The only treatment is supportive care including ventilators, ECMO, etc.
The others aren't spread person to person.
The others aren't spread person to person.
May 7, 2026 at 2:02 AM
The Andes strain, which is what these people have, does have a mortality rate of ~40% and the cause of death is from ARDS. Ivermectin won't do shit. The only treatment is supportive care including ventilators, ECMO, etc.
The others aren't spread person to person.
The others aren't spread person to person.
Today's Paper of the Day is:
60 years of ARDS and the evolution of extracorporeal lung support - from ECMO to ECCO2R
https://criticalcarereviews.com/latest-evidence/paper-of-the-day
Join us to read 1 paper per day and stay up-to-date as we cover the spectrum of critical care across 2026
60 years of ARDS and the evolution of extracorporeal lung support - from ECMO to ECCO2R
https://criticalcarereviews.com/latest-evidence/paper-of-the-day
Join us to read 1 paper per day and stay up-to-date as we cover the spectrum of critical care across 2026
October 1, 2026 at 7:38 AM
Today's Paper of the Day is:
60 years of ARDS and the evolution of extracorporeal lung support - from ECMO to ECCO2R
https://criticalcarereviews.com/latest-evidence/paper-of-the-day
Join us to read 1 paper per day and stay up-to-date as we cover the spectrum of critical care across 2026
60 years of ARDS and the evolution of extracorporeal lung support - from ECMO to ECCO2R
https://criticalcarereviews.com/latest-evidence/paper-of-the-day
Join us to read 1 paper per day and stay up-to-date as we cover the spectrum of critical care across 2026
should APRV be trialed before VV-EVMO?
depends on the specifics of the case (“ARDS” isnt a disease, it’s incredibly heterogenious)
especially for obesity with a component of atelectasis, a 4-6 hr APRV trial may work wonders & avert the need for ECMO
more: https://emcrit.org/pulmcrit/pseudoards/
depends on the specifics of the case (“ARDS” isnt a disease, it’s incredibly heterogenious)
especially for obesity with a component of atelectasis, a 4-6 hr APRV trial may work wonders & avert the need for ECMO
more: https://emcrit.org/pulmcrit/pseudoards/
June 5, 2025 at 1:52 PM
should APRV be trialed before VV-EVMO?
depends on the specifics of the case (“ARDS” isnt a disease, it’s incredibly heterogenious)
especially for obesity with a component of atelectasis, a 4-6 hr APRV trial may work wonders & avert the need for ECMO
more: https://emcrit.org/pulmcrit/pseudoards/
depends on the specifics of the case (“ARDS” isnt a disease, it’s incredibly heterogenious)
especially for obesity with a component of atelectasis, a 4-6 hr APRV trial may work wonders & avert the need for ECMO
more: https://emcrit.org/pulmcrit/pseudoards/
Of course he is free to show that the interview is about longcovid and not ARDS and ECMO treated patients with acute lung damage.
Then the big give aways ....
3/7
Then the big give aways ....
3/7
January 8, 2025 at 9:25 AM
Of course he is free to show that the interview is about longcovid and not ARDS and ECMO treated patients with acute lung damage.
Then the big give aways ....
3/7
Then the big give aways ....
3/7
Extracorporeal membrane oxygenation without invasive mechanical ventilation for acute respiratory distress syndrome: an international cohort study @atscommunity.bsky.social #ECMO
doi.org/10.1093/ajrc...
doi.org/10.1093/ajrc...
Extracorporeal membrane oxygenation without invasive mechanical ventilation for acute respiratory distress syndrome: an international cohort study
AbstractRationale. In acute respiratory distress syndrome (ARDS), extracorporeal membrane oxygenation (ECMO) without invasive mechanical ventilation (IMV)
doi.org
September 25, 2026 at 3:57 PM
Extracorporeal membrane oxygenation without invasive mechanical ventilation for acute respiratory distress syndrome: an international cohort study @atscommunity.bsky.social #ECMO
doi.org/10.1093/ajrc...
doi.org/10.1093/ajrc...
Ja das stimmt.
Wobei ich schon oft wegen “Zuverlegung ARDS Zentrum/ECMO Implantation” alarmiert wurde und sich vor Ort rausstellte, dass einfach keine(r) fundiert ein Beatmungsgerät bedienen konnte.
Wobei es dann glaub ohnehin besser ist den Patienten dort wegzuverlegen. Weit weg.
Wobei ich schon oft wegen “Zuverlegung ARDS Zentrum/ECMO Implantation” alarmiert wurde und sich vor Ort rausstellte, dass einfach keine(r) fundiert ein Beatmungsgerät bedienen konnte.
Wobei es dann glaub ohnehin besser ist den Patienten dort wegzuverlegen. Weit weg.
August 22, 2023 at 1:16 PM
Ja das stimmt.
Wobei ich schon oft wegen “Zuverlegung ARDS Zentrum/ECMO Implantation” alarmiert wurde und sich vor Ort rausstellte, dass einfach keine(r) fundiert ein Beatmungsgerät bedienen konnte.
Wobei es dann glaub ohnehin besser ist den Patienten dort wegzuverlegen. Weit weg.
Wobei ich schon oft wegen “Zuverlegung ARDS Zentrum/ECMO Implantation” alarmiert wurde und sich vor Ort rausstellte, dass einfach keine(r) fundiert ein Beatmungsgerät bedienen konnte.
Wobei es dann glaub ohnehin besser ist den Patienten dort wegzuverlegen. Weit weg.
Ards on VVA #ecmo with an impella for venting. #pocus shows reduced RVOT vti with notching. Repeat later same day after 2ng/kg/min treprostinil shows notching resolved and VTI increased 3 cm. No other changes were made in between. So many chances to nerd out on one case. #pccmsky #emimccm
December 1, 2024 at 2:20 PM
New #ECMOID paper out today!
VAP/HAP are most common ECMO infections, BUT difficult to diagnose due to:
1) Difficulty seeing infiltrates on CXR in ARDS
2) Colonization
We eval’ed factors associated with ➕ cx in ECMO
#IDSky
journals.sagepub.com/doi/10.1177/...
On a personal note (paper #50!)
VAP/HAP are most common ECMO infections, BUT difficult to diagnose due to:
1) Difficulty seeing infiltrates on CXR in ARDS
2) Colonization
We eval’ed factors associated with ➕ cx in ECMO
#IDSky
journals.sagepub.com/doi/10.1177/...
On a personal note (paper #50!)
Clinical characteristics associated with positive respiratory cultures in patients receiving extracorporeal membrane oxygenation - Bryce D. Warren, Erika O’Neil, Michal J. Sobieszczyk, Joseph E. Marcu...
Introduction Hospital – acquired pneumonia (HAP) and ventilator – associated pneumonia (VAP) represent a significant healthcare burden with increased mortality ...
journals.sagepub.com
February 14, 2026 at 5:42 PM
New #ECMOID paper out today!
VAP/HAP are most common ECMO infections, BUT difficult to diagnose due to:
1) Difficulty seeing infiltrates on CXR in ARDS
2) Colonization
We eval’ed factors associated with ➕ cx in ECMO
#IDSky
journals.sagepub.com/doi/10.1177/...
On a personal note (paper #50!)
VAP/HAP are most common ECMO infections, BUT difficult to diagnose due to:
1) Difficulty seeing infiltrates on CXR in ARDS
2) Colonization
We eval’ed factors associated with ➕ cx in ECMO
#IDSky
journals.sagepub.com/doi/10.1177/...
On a personal note (paper #50!)
#ECMO without invasive mechanical ventilation for #ARDS?
🔍 307 adults, at 14 centers (2015-24)
🫁 113 primary awake ECMO
🫁 194 extubated ECMO
⚖️ respectively: strategy failure 40.7% and 24.2%, associated with mortality in both. The leading cause of worsening of respiratory failure.
🔗 bit.ly/4dvDl9G
🔍 307 adults, at 14 centers (2015-24)
🫁 113 primary awake ECMO
🫁 194 extubated ECMO
⚖️ respectively: strategy failure 40.7% and 24.2%, associated with mortality in both. The leading cause of worsening of respiratory failure.
🔗 bit.ly/4dvDl9G
May 15, 2026 at 5:12 PM
#ECMO without invasive mechanical ventilation for #ARDS?
🔍 307 adults, at 14 centers (2015-24)
🫁 113 primary awake ECMO
🫁 194 extubated ECMO
⚖️ respectively: strategy failure 40.7% and 24.2%, associated with mortality in both. The leading cause of worsening of respiratory failure.
🔗 bit.ly/4dvDl9G
🔍 307 adults, at 14 centers (2015-24)
🫁 113 primary awake ECMO
🫁 194 extubated ECMO
⚖️ respectively: strategy failure 40.7% and 24.2%, associated with mortality in both. The leading cause of worsening of respiratory failure.
🔗 bit.ly/4dvDl9G
Obviosuly not widely available, but here's some data on use of ECMO for TB-associated ARDS
#IDSky 🩺
ccforum.biomedcentral.com/articles/10....
#IDSky 🩺
ccforum.biomedcentral.com/articles/10....
Extracorporeal membrane oxygenation for tuberculosis-related acute respiratory distress syndrome: An international multicentre retrospective cohort study - Critical Care
Objective To report the outcomes of patients with severe tuberculosis (TB)-related acute respiratory distress syndrome (ARDS) on extracorporeal membrane oxygenation (ECMO), including predictors of 90-...
ccforum.biomedcentral.com
October 11, 2024 at 2:08 PM
Obviosuly not widely available, but here's some data on use of ECMO for TB-associated ARDS
#IDSky 🩺
ccforum.biomedcentral.com/articles/10....
#IDSky 🩺
ccforum.biomedcentral.com/articles/10....
Legacy of Prof. Gattinoni
🫁 baby lung: concept redefining #ARDS
☢️ physiologic effects of PEEP & how to set it
🩺 prone position: physiological benefits & implications
⚙️ mechanical power: unifying metric for VILI
🩸extracorporeal support to buy time #ECLS #ECMO
@eddyfan.bsky.social
🔓 bit.ly/4hECkfr
🫁 baby lung: concept redefining #ARDS
☢️ physiologic effects of PEEP & how to set it
🩺 prone position: physiological benefits & implications
⚙️ mechanical power: unifying metric for VILI
🩸extracorporeal support to buy time #ECLS #ECMO
@eddyfan.bsky.social
🔓 bit.ly/4hECkfr
March 23, 2025 at 8:31 AM
Legacy of Prof. Gattinoni
🫁 baby lung: concept redefining #ARDS
☢️ physiologic effects of PEEP & how to set it
🩺 prone position: physiological benefits & implications
⚙️ mechanical power: unifying metric for VILI
🩸extracorporeal support to buy time #ECLS #ECMO
@eddyfan.bsky.social
🔓 bit.ly/4hECkfr
🫁 baby lung: concept redefining #ARDS
☢️ physiologic effects of PEEP & how to set it
🩺 prone position: physiological benefits & implications
⚙️ mechanical power: unifying metric for VILI
🩸extracorporeal support to buy time #ECLS #ECMO
@eddyfan.bsky.social
🔓 bit.ly/4hECkfr
#NEJM article on the critically ill BC 13 y/o with #H5N1
-1st ER visit w/ conjunctivitis and fever (d/c w/o treatment)
-3 days later> respiratory distress and hemodynamic instability>admitted
-BiPAP>Intubation> ECMO as pt went into ARDS
#EMSky #MedSky #IDSky
www.nejm.org/doi/full/10....
-1st ER visit w/ conjunctivitis and fever (d/c w/o treatment)
-3 days later> respiratory distress and hemodynamic instability>admitted
-BiPAP>Intubation> ECMO as pt went into ARDS
#EMSky #MedSky #IDSky
www.nejm.org/doi/full/10....
Critical Illness in an Adolescent with Influenza A(H5N1) Virus Infection | NEJM
Influenza A(H5N1) viruses are an emerging zoonotic threat and have spread widely throughout birds in North America. Recently, influenza A(H5N1) infection led to serious illness in a teenager in Canada.
www.nejm.org
December 31, 2024 at 11:58 PM
2) It's curious to think that PP saves severe ARDS but not the most severe of severe ARDS: my opinion: PP doesn't save by itself, but as the sacrosanct pafi improves, it prevents the doctor from doing dangerous stuff. But when the dangerous stuff is already done, like ECMO, PP is useless.
June 8, 2025 at 6:29 PM
2) It's curious to think that PP saves severe ARDS but not the most severe of severe ARDS: my opinion: PP doesn't save by itself, but as the sacrosanct pafi improves, it prevents the doctor from doing dangerous stuff. But when the dangerous stuff is already done, like ECMO, PP is useless.
#ECLS for adults with #ARDS
⚙️ technical aspects
📚 evidence for VV #ECMO & #ECCO2R
🫁 indications & timing
🩺 clinical management
🚦special considerations
🏥 centre volume, logistics, hospital networks
🗺️ ECMO in respiratory pandemics
🔗 liberation from ECMO & outcomes
🔮 future research
🔓 rdcu.be/ezDWp
⚙️ technical aspects
📚 evidence for VV #ECMO & #ECCO2R
🫁 indications & timing
🩺 clinical management
🚦special considerations
🏥 centre volume, logistics, hospital networks
🗺️ ECMO in respiratory pandemics
🔗 liberation from ECMO & outcomes
🔮 future research
🔓 rdcu.be/ezDWp
August 7, 2025 at 3:08 AM
#ECLS for adults with #ARDS
⚙️ technical aspects
📚 evidence for VV #ECMO & #ECCO2R
🫁 indications & timing
🩺 clinical management
🚦special considerations
🏥 centre volume, logistics, hospital networks
🗺️ ECMO in respiratory pandemics
🔗 liberation from ECMO & outcomes
🔮 future research
🔓 rdcu.be/ezDWp
⚙️ technical aspects
📚 evidence for VV #ECMO & #ECCO2R
🫁 indications & timing
🩺 clinical management
🚦special considerations
🏥 centre volume, logistics, hospital networks
🗺️ ECMO in respiratory pandemics
🔗 liberation from ECMO & outcomes
🔮 future research
🔓 rdcu.be/ezDWp
3/n: New World hantavirus infections are rough stuff, once symptoms begin, the resulting cytokine storm and ARDS means there's not much of a window before getting them into an ICU, and often on ECMO, extracorporeal membrane oxygenation, which requires a high level of skill.
May 12, 2026 at 2:12 AM
3/n: New World hantavirus infections are rough stuff, once symptoms begin, the resulting cytokine storm and ARDS means there's not much of a window before getting them into an ICU, and often on ECMO, extracorporeal membrane oxygenation, which requires a high level of skill.