In this episode, I’ll be joined by two experts in the field of adult venoarterial extracorporeal membrane oxygenation – Dr. of Emergency Medicine Joe Bellezzo and Dr. of Pharmacy Ashkan Khabazian.
The next Masterclass for my Critical Care Pharmacy Academy will go live August 4th, 2017 and will be a deeper dive into specific, practical aspects of the pharmacotherapy of ECMO beyond what is covered in this episode. You can sign up to be part of the academy at pharmacyjoe.com/academy.
Links discussed on the show
The episode on the doc bringing arrests from community to cath lab for ECMO
Extracorporeal Life Support Organization
About the guests
Bio for Joe Bellezzo
Joe Bellezzo is the Chairman of Emergency Medicine at Sharp Memorial Hospital in San Diego, California. Joe is the first Emergency Medicine-trained physician to successfully perform ECPR as salvage therapy in a patient with refractory cardiac arrest. Together with Zack Shinar, Joe co-hosts the EDECMO podcast, is co-chair of the Emergency Department ECMO Program at his hospital and is the co-host of the endovascular resuscitation conference “REANIMATE.”
You can connect with Joe here:
@drbellezzo, +drbellezzo, EDECMO contact page
Bio for Ashkan Khabazian
Dr. Ashkan “Ash” Khabazian currently serves as lead emergency room clinical pharmacist at Sharp Memorial Hospital in San Diego. He received his doctor of pharmacy from the University of Michigan in 2004 and then completed a general practice residency at Scripps Mercy Hospital in San Diego, California.
The best part of Ash’s bio was provided to me by Dr. Bellezzo who says:
Ashkan is truly the MAN in our ED. He has changed the way we practice Emergency Medicine and is a true innovator. When I’m coding a patient, regardless of whether we are using ECMO, REBOA, ACLS, or just WI-FI he is there pushing the envelope. He comes to me, all the time, with suggestions on how to best manage pharm issues.
You can connect with Ashkan here:
https://www.visualcv.com/ashkankhabazian
http://www.ashkankhabazian.com/
http://ashkankhabazian.blogspot.com/
https://about.me/ashkankhabazian
https://ashkankhabazian.wordpress.com/2017/07/
https://www.linkedin.com/in/ashkan-khabazian-pharmd-emergency-medicine-16b9b582/
Vasopressin clarification
The vasopressin dose Ashkan uses is 0.03 to 0.04 units per minute (not 0.3 / 0.4).
If you like this post, check out my book – A Pharmacist’s Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies.
Dr. Ashkan Khabazian is amazing!
Dr Khabazian mentioned that during ECMO they preferentially use vasopressin due to the acidosis the patients are frequently in. Is this based on any literature, or is it based solely on the pathophysiology? I did see that vasopressin is naturally released by the body when the body is in acidosis. Is that all the evidence?
Hi Ben! Dr. Khabazian was correctly noting that Vasopressin is a preferred agent because it is unaffected by an acidosis state. All patients who have arrested, and then either gain ROSC or are put on bypass, are initially acidotic – which is always a combination of respiratory and metabolic acidosis from the pathophys of the post-arrest milieu. So for the patient resuscitated with ECPR who is hypotensive, we often start a vasopressin gtt and then add an inopressor (typically norepi) as needed. Anecdotally, we find that we can use lower drip rates of inopressors when used in conjunction with Vasopressin. Hope that helps! ~Joe