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 8, 2025 at 5:47 PM
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
VV-ECMO du soir, espoir...
Quand je vous disais que la grippe était mauvaise, cet hiver...
Quand je vous disais que la grippe était mauvaise, cet hiver...
February 3, 2025 at 10:55 PM
VV-ECMO du soir, espoir...
Quand je vous disais que la grippe était mauvaise, cet hiver...
Quand je vous disais que la grippe était mauvaise, cet hiver...
VV ECMO does improve RV function to a degree so I understand Damien’s concern
October 2, 2026 at 5:21 PM
VV ECMO does improve RV function to a degree so I understand Damien’s concern
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…
ECMO people, do you know of an official algorithm or society recommendations for when a patient should be converted from VV ECMO to VA ECMO. Particularly for pediatrics?
I searched the ELSO website but couldn't find anything.
@theelso.bsky.social
I searched the ELSO website but couldn't find anything.
@theelso.bsky.social
January 29, 2025 at 7:57 PM
ECMO people, do you know of an official algorithm or society recommendations for when a patient should be converted from VV ECMO to VA ECMO. Particularly for pediatrics?
I searched the ELSO website but couldn't find anything.
@theelso.bsky.social
I searched the ELSO website but couldn't find anything.
@theelso.bsky.social
this long-distance interhospital transfer for VV ECMO could have been an APRV trial
Office Meeting GIF
ALT: Office Meeting GIF
media.tenor.com
June 3, 2025 at 6:08 PM
this long-distance interhospital transfer for VV ECMO could have been an APRV trial
We rarely do VV ECMO, so I’m no expert. I wonder though, if RV looks good, is there reason to think it isn’t? Bar a large tricuspid regurgitation, of course.
October 2, 2026 at 2:33 PM
We rarely do VV ECMO, so I’m no expert. I wonder though, if RV looks good, is there reason to think it isn’t? Bar a large tricuspid regurgitation, of course.
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…
Simple answer: you probably can’t as loading conditions all over the place
Practical answer:
On VV you want RV to work as a conduit delivering ECMO flow to lungs
If po2 is OK RV probably works enough
More complex answer:
RV strain and TAPSE/PASP ratio
Practical answer:
On VV you want RV to work as a conduit delivering ECMO flow to lungs
If po2 is OK RV probably works enough
More complex answer:
RV strain and TAPSE/PASP ratio
October 2, 2026 at 11:45 AM
Simple answer: you probably can’t as loading conditions all over the place
Practical answer:
On VV you want RV to work as a conduit delivering ECMO flow to lungs
If po2 is OK RV probably works enough
More complex answer:
RV strain and TAPSE/PASP ratio
Practical answer:
On VV you want RV to work as a conduit delivering ECMO flow to lungs
If po2 is OK RV probably works enough
More complex answer:
RV strain and TAPSE/PASP ratio
'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
The super super sick Covid patients are back.
APRV/TCAV, Steroids, Remdesivir, Proning, VV ECMO
#medsky I hope this is a blip and not a blop.
APRV/TCAV, Steroids, Remdesivir, Proning, VV ECMO
#medsky I hope this is a blip and not a blop.
December 28, 2024 at 1:27 PM
The super super sick Covid patients are back.
APRV/TCAV, Steroids, Remdesivir, Proning, VV ECMO
#medsky I hope this is a blip and not a blop.
APRV/TCAV, Steroids, Remdesivir, Proning, VV ECMO
#medsky I hope this is a blip and not a blop.
@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. ?
Some points imo :
1) With a few exceptions, a PP test should be mandatory before VV ecmo (I had to directly implant a VV- ecmo a few days ago in the immediate post-op period of a colectomy for toxic megacolon, with open abdomen and NPWT...).
1) With a few exceptions, a PP test should be mandatory before VV ecmo (I had to directly implant a VV- ecmo a few days ago in the immediate post-op period of a colectomy for toxic megacolon, with open abdomen and NPWT...).
June 8, 2025 at 6:29 PM
Some points imo :
1) With a few exceptions, a PP test should be mandatory before VV ecmo (I had to directly implant a VV- ecmo a few days ago in the immediate post-op period of a colectomy for toxic megacolon, with open abdomen and NPWT...).
1) With a few exceptions, a PP test should be mandatory before VV ecmo (I had to directly implant a VV- ecmo a few days ago in the immediate post-op period of a colectomy for toxic megacolon, with open abdomen and NPWT...).
Parallel circuits in a patient requiring #ECLS as a bridge to lung #transplantation:
🫁 initial VV #ECMO
🫀 refractory hypoxemia, CA & CS with transition to V-AV
🫀🫁 VP #ECMO after stabilization
🫀🫁🫁 due to ongoing complications, transition to parallel, independent VP + VV #ECMO
🔓 bit.ly/3Xt1Rkr
🫁 initial VV #ECMO
🫀 refractory hypoxemia, CA & CS with transition to V-AV
🫀🫁 VP #ECMO after stabilization
🫀🫁🫁 due to ongoing complications, transition to parallel, independent VP + VV #ECMO
🔓 bit.ly/3Xt1Rkr
March 2, 2025 at 7:20 PM
Parallel circuits in a patient requiring #ECLS as a bridge to lung #transplantation:
🫁 initial VV #ECMO
🫀 refractory hypoxemia, CA & CS with transition to V-AV
🫀🫁 VP #ECMO after stabilization
🫀🫁🫁 due to ongoing complications, transition to parallel, independent VP + VV #ECMO
🔓 bit.ly/3Xt1Rkr
🫁 initial VV #ECMO
🫀 refractory hypoxemia, CA & CS with transition to V-AV
🫀🫁 VP #ECMO after stabilization
🫀🫁🫁 due to ongoing complications, transition to parallel, independent VP + VV #ECMO
🔓 bit.ly/3Xt1Rkr
Fantastic case in @journal_CHEST of an 18 yo who sustained a 40-ft fall leading to traumatic hemorrhagic pneumatoceles and respiratory arrest. Patient was treated with REBOA, parallel-circuit VV-ECMO, and systemic isoflurane sedation; orthopedic fixation was performed on VV-ECMO
August 27, 2025 at 11:07 PM
Fantastic case in @journal_CHEST of an 18 yo who sustained a 40-ft fall leading to traumatic hemorrhagic pneumatoceles and respiratory arrest. Patient was treated with REBOA, parallel-circuit VV-ECMO, and systemic isoflurane sedation; orthopedic fixation was performed on VV-ECMO
So melodramatic.
My title would have been
"Conversion from VV ECMO to VA ECMO, it doesn't suck
My title would have been
"Conversion from VV ECMO to VA ECMO, it doesn't suck
January 30, 2025 at 9:11 PM
So melodramatic.
My title would have been
"Conversion from VV ECMO to VA ECMO, it doesn't suck
My title would have been
"Conversion from VV ECMO to VA ECMO, it doesn't suck
Right ventricular Injury in VV #ECMO
🔍 scoping review
📚 30 studies reported on RVI
📚 23 studies on (heterogeneous) definition
📚 13 studies reported on management, including VP & VA ECMO, positive inotropes, pulmonary vasodilators, ultra-lung-protective MV, PEEP optimization
🔗 bit.ly/4fT9MxG
🔍 scoping review
📚 30 studies reported on RVI
📚 23 studies on (heterogeneous) definition
📚 13 studies reported on management, including VP & VA ECMO, positive inotropes, pulmonary vasodilators, ultra-lung-protective MV, PEEP optimization
🔗 bit.ly/4fT9MxG
January 10, 2025 at 5:37 PM
Right ventricular Injury in VV #ECMO
🔍 scoping review
📚 30 studies reported on RVI
📚 23 studies on (heterogeneous) definition
📚 13 studies reported on management, including VP & VA ECMO, positive inotropes, pulmonary vasodilators, ultra-lung-protective MV, PEEP optimization
🔗 bit.ly/4fT9MxG
🔍 scoping review
📚 30 studies reported on RVI
📚 23 studies on (heterogeneous) definition
📚 13 studies reported on management, including VP & VA ECMO, positive inotropes, pulmonary vasodilators, ultra-lung-protective MV, PEEP optimization
🔗 bit.ly/4fT9MxG
Going from VA ECMO to VV ECMO is satisfying until you realize the lungs need to start doing their job 😡
(Is this the right platform for ECMO tweets?)
(Is this the right platform for ECMO tweets?)
July 15, 2023 at 10:19 PM
Going from VA ECMO to VV ECMO is satisfying until you realize the lungs need to start doing their job 😡
(Is this the right platform for ECMO tweets?)
(Is this the right platform for ECMO tweets?)
If you don’t know what ECMO is here’s a handy dandy overview. Suffice to say it’s desirable to avoid it best you can: mindthegraph.com/blog/va-ecmo/
January 1, 2025 at 3:45 AM
If you don’t know what ECMO is here’s a handy dandy overview. Suffice to say it’s desirable to avoid it best you can: mindthegraph.com/blog/va-ecmo/
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/
I feel like calling this stating the obvious is an insult to stating the obvious.
June 8, 2025 at 7:00 PM
I feel like calling this stating the obvious is an insult to stating the obvious.
Weaning from VV #ECMO: @esicm.bsky.social endorsed WEAN-ECMO survey
🚧 marked variability in current practices
🫁 standardization of criteria/protocols, including monitoring + SGOT duration, may improve comparability and support recommendations
#FOAMcc @intenscaremed.bsky.social
🔓 rdcu.be/eVTEY
🚧 marked variability in current practices
🫁 standardization of criteria/protocols, including monitoring + SGOT duration, may improve comparability and support recommendations
#FOAMcc @intenscaremed.bsky.social
🔓 rdcu.be/eVTEY
December 22, 2025 at 7:03 PM
Weaning from VV #ECMO: @esicm.bsky.social endorsed WEAN-ECMO survey
🚧 marked variability in current practices
🫁 standardization of criteria/protocols, including monitoring + SGOT duration, may improve comparability and support recommendations
#FOAMcc @intenscaremed.bsky.social
🔓 rdcu.be/eVTEY
🚧 marked variability in current practices
🫁 standardization of criteria/protocols, including monitoring + SGOT duration, may improve comparability and support recommendations
#FOAMcc @intenscaremed.bsky.social
🔓 rdcu.be/eVTEY
VV #ECMO in immunocompromised patients with acute respiratory failure: careful, tailored clinical decision regarding ECMO candidacy pivotal!
@asaiojournal.bsky.social
🔗 bit.ly/4oPxFuU
@asaiojournal.bsky.social
🔗 bit.ly/4oPxFuU
VV #ECMO in immunocompromised patients with respiratory failure
🔍 systematic review/meta-analysis (13 studies)
🪦 mortality 63%, significantly higher vs immunocompetent pts
🪦 subgroup analysis highlighted only pts with hematologic malignancy exhibited significantly higher mortality
🔗 bit.ly/4oPxFuU
🔍 systematic review/meta-analysis (13 studies)
🪦 mortality 63%, significantly higher vs immunocompetent pts
🪦 subgroup analysis highlighted only pts with hematologic malignancy exhibited significantly higher mortality
🔗 bit.ly/4oPxFuU
December 6, 2025 at 6:08 PM
VV #ECMO in immunocompromised patients with acute respiratory failure: careful, tailored clinical decision regarding ECMO candidacy pivotal!
@asaiojournal.bsky.social
🔗 bit.ly/4oPxFuU
@asaiojournal.bsky.social
🔗 bit.ly/4oPxFuU