ECLS & Emergency Departments

Editor’s Note: A colleague of mine, Michael, asked me during a conversation if there was any information out there regarding the increased frequency or use of ECLS systems throughout the emergency departments in hospitals across the US.  Interestingly enough, I find myself later in the day, monitoring one of these devices in vivo. Below is […]

Impella Induced Hemolysis

Editor’s Note: A brief note on observed rising K+ levels when an Impella is in place.  If you see a drop in the HCT as well (that exceeds predicted hemodilution from crystalloid infusions) it is possible that there may be a slight malposition of the impella device.  This isn’t always necessarily the case, but hemolysis may be a […]

IABP 101: Preparation and Insertion

Bill– showing us the guidewire and dilator coming together… Editors Note: This is a three part series- “IABP 101” designed to simply refresh or introduce the basic concepts of applying diastolic augmentation for the high risk cardiac patient.  Again, some of the concepts here will seem to be fairly rudimentary for a seasoned perfusionist, but […]

IABP 101: Refresher FAQ

Editors Note: This is a three part series- “IABP 101” designed to simply refresh or introduce the basic concepts of applying diastolic augmentation for the high risk cardiac patient.  Again, some of the concepts here will seem to be fairly rudimentary for a seasoned perfusionist, but if it’s your first day in a perfusion program- […]

The IABP: “Say Hello to our Leettle Friend…”

Increased Afterload Editor’s Note: Although the distance between Perfusion and IABP’s has increased over the years due to smarter consoles, auto-timing features, training of Nursing and Cardiac Cath lab personnel, every once in awhile you find yourself at a clinical site that relies more heavily on perfusionists as a resource for Intra-aortic Balloon Pump therapy. So […]

Starting Your Impella Program: 101

Editor’s Note: I was talking to a fellow colleague, Renee- and we were discussing the different steps associated with implementing an Impella program into the cardiovascular program where she is chief.  The obvious immediate issues are training, staff education, doing the prerequisite number of cases prior to becoming a certified site for this technology, and […]

Perfusion Innovation! Kudos to Quick Thinking

The arrows point to key components that helped make this all work… Editor’s Note: The above picture was posted on the “Surfers FB page, with some caption’s (see below) describing briefly, an event (ruptured RA) post CPB while closing.  I was impressed with the simplicity of the setup and it’s obvious effectiveness. The quest remains- where […]

Unexpected Air: An ECMO Discussion

Editor’s Note: I was on FB and was visiting the Malaysian Perfusion Page, monitoring a discussion regarding venous air entrainment in an ECMO circuit, and the efforts made to save the patient.  This a true emergency, and with a closed system, much more difficult to resolve. The discussion however is what captured my interest because […]

Why We Do This: LVAD_one 2009 Days +

“So yes, we engage hope and strive to do our best, but our vision for this patient’s future is sometimes less than vibrant- for the reasons stated above.  Many of us have become LVAD pessimists.” 2009 days x 24 hours x 60 minutes = 2,892,960 minutes of life support… Editor’s Note: I think there is a tendency […]

Perfusion Art: The ECMO Wishbone

“The ECMO Wishbone“ ___ __Click image to enlarge- Photographer:  Nadia Azuero, BS, CCP Equipment:  Digital:  5S Iphone Editing:  By ‘Surfers:  Saturation Narrative:  The bifurcation of the arterial line for a bridge: ECMO:  “Make a wish” Time & Place:  Estados Unidos About The Artist: Nadia is a Solo Perfusion Contractor, and is currently transitioning to become a physician.  […]

CARDIOHELP: An In-Service for MD’s, Perfusionists, & Nurses

Click Image to visit CARDIOHELP website Editor’s Note: We are looking at a new system to integrate into our ECMO program, and today we had an in-service from MAQUET, who owns, distributes, and supports the CARDIOHELP ECLS system. This was a 3.5 hour in-service designed to educate physicians, perfusionists, and nurses.  It was offered for three […]

PICU Nursing: Honing Your ECMO Skills

Editor’s Note: So I was @ Women’s & Children’s Hospital – here in West Texas, doing some platelet gel cases, when I decided to drop by the PICU to visit friends I hadn’t seen in awhile. The PICU staff was pretty thin- so I asked where everybody was- and found out they were conducting an ECMO wet […]

Letters To ‘Surfers: On The Relevancy of IABP Therapy…

Editor’s Note: Was just going through some mail and stuff- and saw a few comments that I thought were interesting and would like to share. Please respond in the comments section of this post… Frank = Various questions on the relevancy of IABP Therapy = Hi Frank, = = My name is Rahul Barwal. I […]

Plz Take This Survey: The impact of Influenza on Your ECMO Program for 2013-2014

  The impact of Influenza on Your ECMO Program for 2013-2014 Can you please take this short eight question survey on the impact of the recent influenza season on your ECMO program. We will share the results. Click link below to take this survey: https://www.surveymonkey.com/s/RFPNN79 = Thank you. David Palanzo, CCP, LP Penn State Hershey […]

Roundworms & ECMO ? Any Advice, Experience, or Literature?

Editor’s Note: I got an email from a perfusion colleague regarding the impact (if any) of roundworms on the oxygenator for an ECMO run. Please help?  Any information- please forward to the comments section of this blog post, my email, or  Amanda’s email who is running the ECMO. Very much appreciated 🙂 Hey Frank, Do […]

The Avalon Bi-Caval Dual Lumen Catheter

Have you used a percutaneous venous cannula like this? The AVALONELITE :  Bi-Caval Dual Lumen Catheter (Click image to visit website) A Discussion on Cannula Positioning Proper cannula positioning in single site veno-venous extracorporeal life support (vv-ELS) is cumbersome and necessitates image guidance to obtain a safe and stable position within the heart and the […]

And Then Comes Sunday …

24 Hours… of ECMO New Beginnings   (To view the entire “Day In The Life” series Click Here) Jesse Shipman struggles to do a stretch during a therapy session with occupational therapist Megan Taylor at TrustPoint Hospital in Lubbock, Texas Tuesday, June 12, 2011. (Miranda Grubbs/ Lubbock Avalanche-Journal) To view the entire “Day In The […]

H1N1- ARDS- & ECMO (Current Literature)

Editors Note: A big thank you to Marianne Veir Pilger, CCP, and her colleague John @ Meriter Hospital in Madison, Wisconsin for helping out so quickly and hooking us up with the below listed articles on ECMO management for ARDS and H1N1. This is something we are all facing- so I hope it helps. Again- […]

VAD’s & Device Availability List

A ventricular assist device (VAD) is a mechanical circulatory device that is used to partially or completely replace the function of a failing heart. Some VADs are intended for short term use, typically for patients recovering from heart attacks or heart surgery, while others are intended for long-term use (months to years and in some […]

A Marvelous VAD Presentation from China

For every ACTION, there is an EQUAL and OPPOSITE REACTION. This theory impacts life’s varied circumstances, the CAUSE and EFFECT implication… Author / Editor: Co-Editor Anna Lou Villena 🙂 [10] Editor’s Note: This is an extraordinary PowerPoint presentation regarding VAD technology.  It is an eye-opener and definitely well worth viewing. Click image above to view […]

Street_ECMO

Click images to enlarge Editors Note: I got an email from my overseas friend, Dario Fichera, an Italian perfusionist that is very involved in the international perfusion community. (Dario has been involved in perfusion mission work to Africa .) Below are some pictures of a mobile ECMO (Street ECMO) emergency aid station that the Italians […]

An Italian ECMO Transport

Click image to view source article Editor’s Note: I don’t know a lick of Italian, but the pictures were cool, the article was on an Italian perfusion FB group page, the concept is universal, and I wanted to put out an article in Italian to express the flexibility of this Circuit Surfers blog. It’s for […]

VAD / ECMO Policy: Generic & Universal

Editor’s Note: This is a disclaimer: As with all material presented on this site,  please use your own judgement as to what you feel is clinically safe, vetted, and makes sense to you.  This blog is NOT peer reviewed or sanctioned by any perfusion associated review board or academic body. That is not to say […]

LVADers are all Test Pilots…

Editor’s Note: The title says it all.  Joshua is an on-line friend I met almost 2 years ago.  He has had a HeartMate II in for that entire duration plus I believe at least 1 or more years prior.  His story is amazing- and a year ago I did an interview with Josh.  I revisit […]

The CentriMag VAD : Insertion & Cannulaes

The CentriMag Pump Display Console and Drive Units Operative Technique RVAD The right ventricular assist device (RVAD) is usually established with the right atrium as the inflow and the main pulmonary artery as the outflow. LVAD The outflow of the LVAD is the ascending aorta except in unusual cases where the descending aorta or a […]

A Bridge to Transplant? How About a BRIDGE to Medicare?

1/2 a year shy of 65- MEDICARE hasn’t kicked in yet… STRANDED ON THE TARMAC Day:1 Day + Day + ACCESS… DENIED ! Day + Day + Day + Day + Day + Day + Epilog … RIP Click to Enlarge You Figure It Out …

Cardiac Assist Devices for Patients Ineligible for Transplant

Click image to view source article Bridges? Jarvik Heart, a New York-based maker of miniaturized heart assist devices announced Monday that the company has received regulatory approval for a clinical trial designed to test a ventricular assist device for end-stage heart failure patients. The patients are those that are not candidates for an eventual heart […]

HEXMO: Miniaturized ECMO

Click image above to view Source Article Editor’s Note: A submission and link found on Gruppo dei Perfusionisti!!!. Submitted by:  Hiroyuki Kuromitsu This technology is still in the research stages, but seems very workable and sophisticated.  I have no idea about a time table for in-vivo human trials. = = Click image to view entire […]

What Doesn’t Kill You- Makes You Stronger

Click to View…  It’s DEFINITELY Inspiring. This was a link that one of our PICU nurses left on her Facebook page. It totally reminded me of our PICU and the great ECMO nurses we have working there! Ash …  Man she is the greatest !  She linked the YouTube video above. Awesome Murals and Colors […]

LVAD Pioneers… :(

Editor’s Note: This is a painting by Michael-Joshua Morris.  He is a friend, a frequent contributor to this blog, as well as his own, and has been incredibly courageous in his efforts to promote awareness of VAD technology.  He has had a  Heartmate II for two years and counting. He just lost a friend…  that’s […]

An ECMO Lecture : Outstanding !

PART 1 of 2. Hergen Buscher, a German intensivist who lives and practices in Sydney, gives an excellent presentation on extra corporeal membrane oxygenation in the modern era of ICU. This was presented at a Sydney Intensive Care Network meeting on the 17th March 2011. Go to www.intensivecarenetwork.com for more information about who we are […]

What Doesn’t Kill You- Makes You Stronger

= Click to View…  It’s DEFINITELY Inspiring. This was a link that one of our PICU nurses left on her Facebook page. It totally reminded me of our PICU and the great ECMO nurses we have working there! Ash …  Man she is the greatest !  She linked the YouTube video above. Awesome Murals and […]

The Role of Perfusionists During ECLS ?

Hi Frank, How are you? I need your help because I’m collecting some data about the role of perfusionist during ECLS in US, to compare with the role of perfusionist in Italy. Could you help me sending some data, protocols and other stuffs? Thanks in advance. Emiliano. emiliano@perfusione.net I got the above email from a […]

A Day in the Life… [And Then Comes Sunday]

24 Hours… of ECMO Jesse  struggles to do a stretch during a therapy session with occupational therapist Megan Taylor on Tuesday, June 12, 2011. (Miranda Grubbs/ Lubbock Avalanche-Journal) Click Image Above to View Video Interview… The End and a new beginning This is the culmination of Jessie’s story.  His life is a new chapter now, […]

A Day In The Life… [6] Reprint

24 Hours… of ECMO To view the entire “Day In The Life” series Click Here Part VI:  A New Day & Definitely a New Beginning ! 8:00 am Coffee, Bugles, and McyDee’s I know it’s a bad example, but the hospital cafeteria is being remodeled, so I stocked on provisions for the long term.  There […]

A Day In The Life… [5] Reprint

24 Hours… of ECMO To view the entire “Day In The Life” series Click Here Part V:  Past Midnight… Ghost Stories & What-Not 3:00 am Ghost stories So it’s 3 a.m. and the STS paper work has become a mountainous blur, our ECMO patient is on “cruise control”, the hive activity is down to almost nothing, […]

A Day In The Life… [4] Reprint

24 Hours… of ECMO To view the entire “Day In The Life” series Click Here Part IV:  Past Midnight Saturday:  1:00 am STS and the Paperwork Deluge So at something like 1:00 am, it’s do or die time.  The patient is fine, but as an ECMO coordinator, I typically like to stay awake and support […]

A Day In The Life… [3] Reprint

24 Hours… of ECMO To view the entire “Day In The Life” series Click Here Part III:  Getting Past Midnight :   ACT’s & Clots … 11:00 pm Somehow during the initial debriefing from the previous ECMO coordinator that I had taken over for, the question of reliability regarding our ACT  (Activated Clotting Time) came […]

A Day In The Life… [2] Reprint

24 Hours… of ECMO To view the entire “Day In The Life” series Click Here Part II:  The Setting … 9:00 pm Well it’s about that time.  The PICU is closed for business, onlookers, rubber-neckers, and pretty much any visitors not directly related to your patient, are ushered away- and the staff is settled in […]

A Day In The Life… [1] Reprint

24 Hours… of ECMO To view the entire “Day In The Life” series Click Here Part I:  Getting Started … 24 hours to the finish line, and all you can do is just hope you don’t trip and fall.  That pretty much sums up this ECMO run.  Just trust your feet, and don’t lose sight […]

The Joshua Story [2]

The Joshua Interview: (Click Image above to Visit Josh’s Website) Editors Note:  Josh is a HeartMate II recipient and is awaiting a heart transplant.  Please click here   if you are unfamiliar with his story and would like to see how we got to the point of doing this interview. On 06/09/2011 Hello Joshua, this is […]

When the Bullet Hits the Bone …

The title of this may seem odd, it is from a song back in the mid-80’s. It just popped into my head when thinking about writing this.  But today it seems an apt metaphor for this particular story.  It’s when reality hits,  the movie part is over, and life turns to get a bit more […]

The Essential Ingredient: ECMO Nurses

(Meet An Amazing Nurse ) I met Shannon 3 1/2 years ago when doing my first ECMO shift here in Texas.  I was pretty clueless about ECMO, as despite 17 years of experience, I was new to this hospital, and I had only worked in adult perfusion programs throughout my career. I had gotten a […]

Bi-Caval Dual Lumen Catheter

Have you used a percutaneous venous cannula like this? The AVALONELITE :  Bi-Caval Dual Lumen Catheter (Click image to visit website) We are looking for a percutaneous cannula that transits the internal jugular to the superior vena cava, right atrium, and inferior vena cava. I have looked at this cannula online, but it looks like […]

And Then Comes Sunday …

Jesse Shipman struggles to do a stretch during a therapy session with occupational therapist Megan Taylor at TrustPoint Hospital in Lubbock, Texas Tuesday, June 12, 2011. (Miranda Grubbs/ Lubbock Avalanche-Journal) To view the entire “Day In The Life” series Click Here The End and a new beginning This is the culmination of Jessie’s story.  His […]

The Joshua Story [2]

The Joshua Interview: (Click Image above to Visit Josh’s Website) Editors Note:  Josh is a HeartMate II recipient and is awaiting a heart transplant.  Please click here   if you are unfamiliar with his story and would like to see how we got to the point of doing this interview. On o6/09/2011, Teutonic 13 wrote: Hello […]

The Joshua Story [1]

A Bridge  to ? A while ago I got a tweet from someone I didn’t know at all… I don’t get a lot of major league support or endorsements from people that visit here, but certainly I have gotten plenty of encouragement. To get a comment like this, from out of the blue was a […]