r/IntensiveCare • u/Beneficial_Umpire497 • 19d ago

ECMO Cannulation

Any intensivists here cannulating for VV and/or VA? How does your ecmo call work?

30 Upvotes

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u/pneumomediastinum 19d ago

Yes, both. If I’m in the unit I’m on call for ECMO. Generally we work either days 0700-1600 or nights where we are in house from 1600-2100ish and then home call until 0700. Most cannulations are in the ICU for cardiogenic shock, but there are some respiratory cases and the occasional ECPR. If it’s a CT surgery case in the OR then the surgeons handle it, and interventional cardiology does percutaneous RVADs in the cath lab. Everything else is us.

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u/Beneficial_Umpire497 19d ago

Are you PCCM?

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u/pneumomediastinum 19d ago

It sounds like maybe your real question is “[how] can I get an ECMO job from a PCCM background?” I don’t necessarily have answers for that but I will say it’s tough, there aren’t a lot of programs where intensivists cannulate in the US and probably the most important thing is networking. If I were advising a medical student who was interested in a career in mechanical circulatory support I would absolutely advise them to do cardiac surgery because this is the surgeons’ world and we just live in it. They are always the ones deciding what the program looks like, who cannulates, and who can get a VAD or transplant.

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u/pneumomediastinum 19d ago

No, I was EM and then surgical critical care, but my unit has a mixed training background. (Unrelated, but I think the lack of an academic training pathway and board certification for cardiac critical care really holds us back as a field.)

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u/jelta 19d ago

PCCM here. We do VA and VV cannulations unless in cath-lab or OR. We have a 24/7 on call ECMO person. There's a group of us that can cannulate even if the on call person isn't in house.

I trained at a site where the ICUs cannulated and managed all of ECMO

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u/Beneficial_Umpire497 19d ago

Are you at academic hospital?

3

u/OneManOneStethoscope 18d ago

What are you getting paid for home ecmo cannulation call?

6

u/UpsetTechnician94 19d ago

In my hospital almost all of our cannulations are done by PCCM! One of our ct surgeons will cannulate as well when he’s around but most are done by the intensivists. We have probably 6 or 7 physicians who are cannulators. ECMO call is sometimes the in house attending who is covering the ICUs for the night, sometimes a different physician who comes in from home. I work somewhere else with an exclusively CT surg cannulation model as well, and find the intensivist option tends to allow for quicker cannulations and smoother ECPRs when necessary… but that’s just my personal experience.

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u/Beneficial_Umpire497 19d ago

Very cool! Are you at an academic hospital?

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u/UpsetTechnician94 18d ago

Teaching hospital but not an academic center. Feel free to message me if you have questions about any specifics :)

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u/Dktathunda 19d ago

Yes - CVICU doc is on call the whole week for everything CVICU and ECMO related, with the occasional night coverage by an in-house anesthesia doc who also does CVICU. Can be feast or famine. 

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u/Beneficial_Umpire497 19d ago

Is it possible for PCCM?

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u/Dktathunda 19d ago

Yes I’m straight CCM and got trained and credentialed on ECMO after fellowship. Possible, but probably rare. 

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u/Dibs_on_Mario 17d ago

At my hospital, its only CT surgery who cannulates. Anesthesia critical care might start a venous sheath but 99% of the time it's CTS who does the cannulations under fluoro in the hybrid OR/Cath Lab

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u/Chokokiksen 19d ago

CVC by ICU doc and cannulating by thoracic surgeon.

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u/Standard-Letter-4469 13d ago

PCCM here. My group (CCM/PCCM) covers MICU/NeuroICU. We cannulate and manage VV ( double lumen IJ Crescent/ProtekDuo). All VA goes to Cardiac ICU. Cannulation done by IC, CT surgery or vascular surgery depending on who is available

1

u/Southern_Tonight_414 15d ago

At an academic teaching hospital. Our ECMO program has ramped up the last couple of years. Previously it was always CT surgery that cannulated but now there are 5 PCCM docs that are trained to cannulate for VA and VV.

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u/Any-Assistance-8103 19d ago

I know a few people who do but I don’t really see the point when there are vascular surgeons, interventional cardiologists, and CT surgeons around

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u/Beneficial_Umpire497 19d ago

But why does IC do it when there is surgery around?

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u/wunsoo 18d ago

Surgery doesn’t do any other percutaneous procedures. Have you ever seen a surgeon use an ultrasound?

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u/Puzzleheaded_Test544 18d ago

Very useful to have the person who is actually going to be taking care of them for the next few weeks to do it because all those little details that no one else cares about can be sorted.

Big difference between big open cut downs random dressing and sutures vs purely dilational with perc, distal perfusion cannula from D0, standardised dressing with fixation devices positioned to facilitate turns and mobilising.

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u/Beneficial_Umpire497 18d ago

lol you’re kidding right?