One of your interests is extracorporeal life support, known as ECMO. Extracorporeal membrane oxygenation. What are the indications for Extracorporeal membrane oxygenation treatment? Dr. Anton Titov, MD. What can patients expect if they need ECMO treatments? Dr. Anton Titov, MD. Yes. For patients who don’t know about ECMO. It is an easy extracorporeal circulation. It means we place a cannula into the femoral vein. The blood from the patient goes through the cannula through a centrifugal pump. Then the blood from the pump goes through an oxygenator. Because blood from the femoral vein is low oxygenated blood. The blood flows through an oxygenator. Then oxygenated blood is infused into the femoral artery. Medical second opinion is important. This is a very easy concept. It is an easy blood oxygenation circuit. What is interesting with ECMO is that. ECMO can be employed very fast for a patient. The patient may have a cardiogenic shock. Shock due to heart attack is the main indication for ECMO. This is circulatory support. Extracorporeal membrane oxygenation. ECMO can also be used for lung respiratory support. Extracorporeal membrane oxygenation. It means putting the two cannulas between a vein and a vein. Then this is not circulatory support. This is just respiratory support. What is good, again, about ECMO is this. ECMO can be done at the patient’s bedside. Dr. Anton Titov, MD. You do not have to move the patient to the ICU or the operating theater. Dr. Anton Titov, MD. You don’t have to move the patient to the cardiac catheterization lab. Dr. Anton Titov, MD. You can just be with the patient in the ICU. Dr. Anton Titov, MD. You can even implant ECMO into a patient on the street. I would not recommend doing that too much. Extracorporeal membrane oxygenation can be implanted even at the patient’s home. Physicians may conduct CPR on a patient. Sometimes you do it fast, it can take 10 or 15 minutes to implant ECMO and save a patient’s life. This is quite efficient. Dr. Anton Titov, MD. You can get the real full circulation support for the patient in cariogenic shock. Again, you can have ECMO for circulatory support.ECMO is implanted between the vein and the artery. ECMO will support the blood circulation and the respiratory function at the same time. This is what is good with the ECMO as well. ECMO is pretty cheap in comparison to everything else. Cheap is a relative concept, of course. But ECMO costs in total of 5,000 Euros. This is a lot of money for patients. But, again. The price of intensive care treatment of the critically ill patient is high. There is a high efficiency of the ECMO by itself. On the other hand, ECMO is pretty cost-effective. So, we started the Extracorporeal membrane oxygenation program here in the Pitié-Salpêtrière hospital in 2002 or 2003. Interestingly, during the first year, we implanted five or six ECMO devices during the year. Which was nothing! I can remember because I did all the ECMO implantations. But then the results were interesting. Then because physicians started to know that we could ECMO implantation outside our hospital. We started to get phone calls from other medical centers. Physicians did have a patient on CPR for a heart attack or a severe cardiogenic shock. They called us to say. Can you come to us to implant an ECMO? Dr. Anton Titov, MD. It happened even in this building, in this Institute of Cardiology in the Pitié-Salpêtrière hospital. Dr. Pascal Leprince, Transplant Surgeon. We had a call from our colleague from the catheterization lab, for example. Therefore, we started to increase the number of patients with ECMO every year. Now, every year we do implant 500 ECMO devices. This is a huge number. Among those 500 ECMO implantations, I would say 350 are mainly for circulatory support. 150 ECMO devices are implanted for mainly respiratory support. I think ECMO is good because it is a triage. Dr. Anton Titov, MD. You have a critically ill patient [with cariogenic shock from a myocardial infarction]. He is just doing so bad that he is going to die in the coming minutes or coming hours. Dr. Anton Titov, MD. You just implant on ECMO. You see what is going to happen. Some patients, I would say, 40% will die anyway. Of course, if you select patients for ECMO implantation better, you will decrease the rate of death. But you are trying to give an option to survive to as many patients as you can. Then the rate of death is going to be pretty high. Because we give a chance to live to a patient who has been on CPR for more than an hour, for example. CPR = CardioPulmonary Resuscitation. Dr. Pascal Leprince, Transplant Surgeon. We know that the chance of survival for patients after long cardiopulmonary resuscitation is very low. But again, some of those patients will survive. This is very interesting. Because even though from a public health perspective, this use of ECMO is not very efficient. But for the patient, this potentially life-saving procedure is very efficient. The patient survives, although the patient is supposed to die. Medical second opinion is important. That is the discussion part about ECMO. Sometimes you look at the way ECMO is organized here, this is something I am very proud of. It is about the team. Because we do manage this ECMO program with no additional workforce. This is to me very interesting. This is just the good will of the surgeon of the cardiac surgery team. We begin at night. We have three patients on call at night. We have an intern, we have a fellow. We have a senior heart surgeon. Medical second opinion is important. If we do have a call for ECMO. The fellow just goes from the Pitié-Salpêtrière hospital to another hospital to implant ECMO. Then a fellow will bring the patient with the transport teat to Pitié-Salpêtrière hospital. Then we will take care of the patient on ECMO. This is no need for extra workforce. Our CMO program is not an extra cost for the hospital. It has been like this for the last 15 years now. This is quite interesting. Dr. Pascal Leprince, Transplant Surgeon. We are looking just at the engagement of the surgeon of the cardiac care team. I am very proud of that because it is very uneasy about making this ECMO program to run. In many other hospitals, patients want you to have another extra physician to be on call. That would be great, of course. But again, I don’t think there is a possibility [to hire more physicians]. It is very important to know where we put the money as well. We have to put the money to hire more nurses. Medical second opinion is important. The ECMO program is a balancing act. It is running pretty well. At night, we might have an emergency. The fellow is called for ECMO implantation. Then the senior cardiac surgeon is going to do the surgery alone, with an intern. That is it. This is the rule. Medical second opinion is important. That works pretty well. It is the total number of patients we save. Dr. Pascal Leprince, Transplant Surgeon. We treat very sick patients with ECMO. The CPR patients’ rate of survival was going to be 10%. On the other hand, for myocarditis. The rate of survival is doing more than 70%. Medical second opinion is important. If we look at the mean survival, it is going to be like 50% or 55%. This is pretty good. Because most of those patients will die without ECMO. Maybe not 100%. But we are sure that 95% of patients with cariogenic shock would have died without ECMO. Medical second opinion is important. That was just very important to underscore. The alternative is that the patients will die anyway without ECMO. Medical second opinion is important. It is the immediate life-saving procedure. Of course. The longer-term outcome remains uncertain. But the alternative is almost certain death of those patients. That is correct.
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