ECMO is usually applied to the whole body. In VA-ECMO, we often use a smaller side cannula to supply the lower limb with circulation and oxygenated blood, when its femoral artery is partially occluded by the main ECMO cannula.
Selected lower limb perfusion
The Germans took this one step further during a traumatic amputation victim who had a complete amputation of the leg at the level of the pelvic ring. They connected the amputated limb to an ECMO circuit. The limb was cannulated at the torn femoral artery and vein and perfused with 1L/min for 12 hours, to keep it circulated and alive for long enough to stabilise the patient and use tissue from the amputated limb for reconstructive surgery.
The result was the patient had enough tissue to do a reconstruction that allowed him to get a working prosthetic limb and return to work 5 months later.
The case was presented at the 47th Annual Meeting of the German Society for Thoracic and Cardiovascular Surgery (DGTHG) in Leipzig, Germany, February 2018, but unfortunately, only the abstract for the case is available online. Still, a very interesting case and great outside-the-box thinking.
Extracorporeal Circulation in a Trauma Patient: An Unusual Case of Selected Lower Limb Perfusion, Thorac cardiovasc surg, 2018.
This experimental study puts most common assumptions about hyperventilation in hemorrhagic shock on its head. Common thinking is that trauma pts breathe faster because of shock and metabolic demands not being met. This study suggests trauma pts are breathing faster to elicit a respiratory pump with the negative inspiratory pressures that will enhance cardiac preload. More>>
Is systolic blood pressure (SBP) of 90 the magic threshold in traumatic brain injury (TBI)? This observational paper goes through a large prehospital database, and found an association between lower systolic BP and higher mortality. This has created a lot of discussion on current goals for BP in TBI – but it needs to be pointed out the article is observational – we don’t yet know if manipulating these blood pressures higher will be good for TBI patients. More>>
The Big Sick 18 #TBS18 conference is done and we’re catching up on sleep and all the impressions from a great week with learning, discussions and fantastic people, check out our programme on www.bigsick18.org – and here’s an excellent recap video of #TBS18 from Marius Klausen (also, read more below).
The Big Sick conference #TBS18 is coming, and we’re getting fired up for three days of cutting edge critical care conference with top speakers and top delegates. We can’t wait to meet you all to learn and discuss and connect.
We now have 4 available spots on offer, due to some delegates not able to make it to Zermatt after all.
Being a small conference, we would love to have all our seats filled, so if you’re available to come to Zermatt feb 7-9, please get in touch through this website or the conference website to secure a ticket.
Small & friendly, huge on learning
It will be three fantastic days with a small and friendly group of 50 delegates, to ensure interaction with other delegates as well as with our speakers. And our co-operation with Air Zermatt will bring excitement and pre-hospital winter learning to the conference, to spice up and add to our sessions on airways, ECMO, cardiac arrest, pre-hospital care, trauma and deep dives into more philosophical sides of critical care and medicine. Please see the programme and list of speakers for more details.
During the busy times of conference preparation, we apologise for the lack of posts on our ScanCrit blog. We will be back to normal service after the big sick conference, with lots of goodness from the conference.
We can’t wait to come to #TBS18 in Zermatt and meet everyone – we hope to see you there!
We have worked hard this year on something big that is due to kick off in February next year: TBS18, The Big Sick Conference – a small, social critical care conference with top speakers and deep medical engagement in the amazing alp village of Zermatt at the foot of the Matterhorn.
We wanted to create the conference we’d most like to attend ourselves, and The Big Sick is concentrating on the first hours of the sickest patients, their physiology and how we should deal with them. More>>
Recently saw BIS discussion re-surface. NICE recommends it, yet very few use it. We could make a long discussion about this, but the short version is we sometimes use it, despite its shortcomings. Its best use would presumably be in patients with neuromuscular blockers onboard. Problem is BIS value seems to be affected by neuromuscular block alone. More>>
A great Scandinavian conference is coming up October 10-11th 2017! In the small, but beautiful town of Sundsvall, Fredrik Granholm has managed to lure some of the great minds and presenters within tactical trauma and trauma care to gather there. The ScanCrit team is coming as well. We’re proud to be part of this, and we’re greatly looking forward to hanging out with like-minded trauma heads and nerdily discuss and enjoy these two days!
It will be a diverse gathering of physicians, EMS, police anti terror units, military and fire & rescue services working with pre-hospital trauma in a tactical/hostile environment. In the spirit of SMACC and its likes, TacTrauma17 will focus on world class presentations as well as the networking and discussions within the group of delegates and presenters mingling throughout the conference.
Several well know presenters will be there. Among them: Mark Forrest of ATACC fame, Mike Lauria who’s into decision making and CRM, Stephen Sollid with great experience from Norwegian HEMS operations, and the always entertaining and interesting Richard Dutton of Maryland Shock Trauma center – you can catch an entertaining and interesting interview of him at EMCRIT to warm up for Tactical Trauma 17. And if you can’t make it, be sure to follow the #TacT17 hashtag on Twitter!
Have a look at the full programme here.
Hope to see many of you there!
Iloprost is a powerful vasodilator, but I have never seen it used as an intravenous infusion to improve general microcirculation in septic shock, like in this interesting, albeit very small, case series from Intensive Care Med.
In septic shock, one of big “organs” affected is the microcirculation. In addition to being a vasodilator, iloprost hampers clot formation and induces fibrinolysis, all of which can be beneficial in improving microcirculation in septic shock. More>>