PerfWeb 23 – Concepts in ECMO – (Part 1) ECMO Cannulation Strategies, ECMO Economics, ECMO Selection

Faculty: Joseph Basha, CCP John Ingram, CCP Matt Warhoover, CCP
Concepts in ECMO–Part 1
0:00 Open
9:40 Delivery of Oxygen and Acute Renal Injury, Making the Connection–John Ingram, CCP
16:50 Acute Kidney injury
- Incidence and diagnosis
- What is acute kidney injury
- Risk factors
- Renal anatomy and physiology
- Delivery of oxygen
- Conduct of perfusion and alpha 1 vasoconstrictors
- Post CPB renal failure mortality rate
- The AKIN clasyfication
- Bun and creatine
- The search of better biomarkers of AKI
- Common AKI biomakers
- Biomarkers by segment of the nephron injured
25:57 - Acute kidney injury types and categories:
- Risk factors pre-operative
- peri-operative
- post-operative
30:22 - The nephron - the functional unit of the kidney
32:35 - Nephron forms urine in three steps
- Filtration
- Re-absorption
- Secretion
48:57 - Renal Blood Flow
1:05:19 - Delivery of oxygen and how is determined
Cardiopulmonary Bypass; is our use of Phenylephrine Causing Acute Kidney Injury?–John Ingram, CCP
1:14:25 - Oxygen delivery on bypass and hypo-tension increase acute kidney injury risk after cardiac operation
1:15:44 - does our use of Phenylephrine on CPB play a role in post operative acute kidney injury
1:16:40 - Phenylephrine prescrybing information manufacturer's insert
1:21:35 - Phenylephrine's renal vasoconstrictive action
1:29:00 - evaluate the AKI risk factors
1:29:58 - pre-operative AKI risk factors
1:31:10 - peri-operative AKI risk factors
1:32:07 - post-operative risk factors
1:34:39 - ECMO economics–Matt Warhoover, CCP
1:39:26 - ECMO initiation
1:44:50 - can CMS close it in the US?
1:49:21 - Center for Medicare Services - reimbursement for ECMO
1:53:20 - ECMO in adults in the US - impact and implications (outcome % of survived, hospital length of stay, ECMO days, respiratory support)
1:55:34 - pushback from healthcare systems (centrally Cannulated, peripherally Cannulated, average total hospital charges)
1:57:49 - updates to ECMO MS-DRG reimbursement (ECMO continuous, ECMO central, ECMO peripheral veno - arterial, ECMO Peripheral veno - venous)
2:00:39 - Relevant MS-DRG reimbursement (assistance with cardiac output using Impeller pump, Intermittent, assistance with cardiac output using Impeller pump, continuous, other heart assist systems implant).
2:01:49 - examples of professional and hospital billing and the resulting of reimbursement. ( central ECMO. respiratory system diagnosis with ventilator support, heart failure and shock with mcc or peripheral ECMO, cardiac arrest, unexplained with mcc or peripheral ECMO, septicemia or severe sepsis with mv).
2:04:12 - Pushback from providers:
- alternative cannulation strategies ( sport model, centralized venting, pVAD intersection)
- alternative management strategies (Tracheostomy)
2:16:27 - Discussion
ECMO Basics
What is ECMO?

[mariespi]

I have a loved one on ECMO who also got sepsis which caused acute kidney failure. Seems to me that their plan is just to wait and see if the kidney will start working again. While they are on dialysis, the mode was changed to pull fluids to help his lungs but I think he got dehydrated and it affected his blood pressure. But they don't seem to do anything to help the kidneys other than doing dialysis. It's more of a wait and see strategy which is not really a strategy. Now, they're telling me he would not qualify for a lung transplant because he also has kidney failure. That is messed up! He got sepsis while on ECMO which is a common infection in hospitals and now finding out it's very common on patients on ECMO which causes kidney failure.😭

[mariespi]

Is epinephrine the same as phenylephrine?