EMS World

AUG 2017

EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.

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40 AUGUST 2017 | EMSWORLD.com Device: Extracorporeal Life Support/Extracorporeal Membrane Oxygenation (ECLS/ECMO) Manufacturer and Website: Maquet Get- inge Group, https://www.maquet.com/us/ Physician commentary: Marc Conterato, MD, emergency and trauma, North Memo- rial Health; Demetri Yannopoulos, MD, pro- fessor of medicine and emergency medi- cine interventional cardiology, University of Minnesota (was not in attendance but provided commentary via his expertise) Imagine the ability to sustain in the field or in the cardiac cath lab the heart and lungs of a patient in cardiac arrest. With a new device that's about the size of a portable cardiac monitor, this ability has come true. The CARDIOHELP device is touted by its manufacturer, Maquet Getinge, as the world's smallest heart-lung machine. With the latest science showing that cardiac arrest patients with refractory ventricular fibrillation (VF) benefit from treatment in the cath lab, physicians such as Demetri Yannopoulos and Marc Conterato are considering the possibilities of providing extracorporeal life suppor t (ECLS) or extracorporeal membrane oxygenation (ECMO) in a mobile unit that can meet transported patients at the door of the receiving facility. "Technology and lifesaving treatments like compac t ECMO devices can be delivered to the patient much faster than the patient can be delivered to the hospital," says Yannopoulos, whose University of Minnesota Medical Center is currently the only hospital in the country that systematically accepts in the cath lab patients who are in refractory VF. Currently, the thought is that a mobile ECMO unit would be on call at all times, and when alerted, would rendezvous with the patient and crew at the receiving facility to put the patient on ECMO and normalize circulation as early as possible. That way, the cath lab can receive a patient in dire need of catheterization, but one who is not receiving active compressions from a mechanical CPR device, making the delicate procedure of stenting more difficult. Already, Conterato and Yannopoulos are seeing in their protocols with ECMO increased rates of survival to neurologically functional discharge in these patients (~48% in the first 100 patients). Refractor y VF patients are brought to cath labs by EMS providers who have followed the protocol to identify them as such, then put on ECMO and revascularized. "VF is a timer, so to speak, meaning there is still substrate to work with," says Conterato. Other criteria for entry into this protocol is that the patient is between 18 and 75 years of age and has failed to be converted from the arrhythmia after three defibrillations. While not all interventional cardiologists are trained on the ECMO procedure, Conterato sees a future in which trained physicians can use a telehealth or remote- monitoring device to provide medical direction to the field from a base station such as the hospital. "We need to be thinking about this as we did with the whole concept of identifying trauma centers and realizing that with the correct time-sensitive resources, these are survivable conditions," Yannopoulos says. "I predict prehospital ECMO is going to be a novel field of its own." Device: SAM Junctional Tourniquet Inventors: Sam Scheinberg, MD, CEO, SAM Medical; Lance Hopman, director of research and development, SAM Medical Company and Website: SAM Medical, sammedical.com Physician commentary: Arthur Yancey, associate professor of emergency medicine, Emory University, Atlanta, Ga.; medical director, Grady EMS Emergency Communi- cations Center There are likely very few EMS providers who haven't heard of SAM: SAM splints, SAM pelvic binders and SAM chest seals are all respected products and are used in many EMS services. So when the U.S. Army Institute of Surgical Research called on the medical device industry to invent a tool that could control femoral or inguinal hemorrhage, it was no surprise that Sam Scheinberg's company, SAM Medical, responded. Their invention, the SAM Junctional Tourniquet, was adopted by the U.S. Army for use in the field, and also won the Army's Major General Harold "Harry" Greene Award for Innovation, both in 2015. The military saw success after the widespread adoption of limb tourniquets, but was presented with multiple cases of death from exsanguination in patients who underwent high limb amputations, especially in the junctional area between the torso and the upper leg. Arthur Yancey, MD, medical director of the Grady EMS Emergency Communications Center in Atlanta, stresses the value of a device such as the SAM Junctional Tourniquet. "Because the major blood vessels that run between those areas in the body are very difficult to access, an injury to the femoral artery is one of the most lethal wounds you can have," he says. "It may be a rare occurrence, but it is often lethal." Lance Hopman is director of research and development at SAM Medical, as well as the device's inventor. Scheinberg's background as a trauma surgeon in Vietnam gives him a unique perspective on injuries such as these. Hopman and Scheinberg focused on the fact that blast injuries that create high limb amputations carry enough energy to also cause concurrent pelvic fractures. These

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