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CAMPUS GROSSHADERN - HERZCHIRURGISCHE KLINIK UND POLIKLINIK HERZKLINIK AM AUGUSTINUM ECMO as Bridge to Lung Transplant Ambulatory V/V&V/VA ECMO: How to do it & Building the Team Christian Hagl Department of Cardiac Surgery, University Hospital Munich (LMU), Germany Disclosure: The author declares no conflict of interest

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Hannover Medical School Munich University Hospital 11/2011 Lung transplant program

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Waiting list eurotransplant LAS

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The rule of ECMO in transplantation Am J Respir Crit Care Med Vol 185, Iss. 7, pp 763768, Apr 1, 2012

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Technical Advances

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The Munich Experience

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Staff and organization (respiratory failure) Department of Anesthesiology Medical Department I/ Pneumology Department of Cardiac Surgery Department of Thoracic Surgery

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Department of Cardiac Surgery Medical Department I (Cardiology) Heart Team Staff and organization (cardiac failure)

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MUNICH ECMO/ECLS Network Physicians Nurses Perfusionists Scrub nurses Transport specialists Special transporta tion ICU +

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CAMPUS GROSSHADERN CAMPUS INNENSTADT LOREM IPSUM SETUR ALARME In-house ECMO/ECLS Logistics + Implementation In-house ECMO/ECLS Logistics + Implementation

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Herzchirurgische Klinik an der LMU Herzklinik am Augustinum KLINIKUM DER UNIVERSITT MNCHEN in-house call ECLS Implantation by cardiac surgeon and perfusionist alarm approx.: 200 x year (Cardiac surgeon at ICU) locations: cathlab, emergency room and Intensive Care Unit

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Herzchirurgische Klinik an der LMU Herzklinik am Augustinum KLINIKUM DER UNIVERSITT MNCHEN Content of emergency trolley: v-a cannulas in all sizes, Seldinger guide wires, material, etc. ICU emergency room cathlab nursing unit in-house equipment for ECLS implantation Clinic goes to patient

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Herzchirurgische Klinik an der LMU Herzklinik am Augustinum KLINIKUM DER UNIVERSITT MNCHEN Decision making process after ECLS implantation Heart Team

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Herzchirurgische Klinik an der LMU Herzklinik am Augustinum KLINIKUM DER UNIVERSITT MNCHEN in-house call ECMO Anesthesiologist or cardiac surgeon and perfusionist alarm approx.: 100 x year (anesthesiologist at the ICU) locations: Intensive Care Unit Decision for implantation in transplant candidates

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CAMPUS GROSSHADERN CAMPUS INNENSTADT LOREM IPSUM SETUR ALARME External ECLS/ECMO Logistics + Implementation External ECLS/ECMO Logistics + Implementation

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Herzchirurgische Klinik an der LMU Herzklinik am Augustinum KLINIKUM DER UNIVERSITT MNCHEN external emergency call (ECMO/ECLS) request to the attending senior physician doc to doc conversation implantation in external hospitals by experienced ECLS team (ECLS: cardiac surgeon + perfusionist) (ECMO: anesthesiologist or cardiac surgeon + perfusionist) Transport by cardiac surgeon +/- anesthesiologist + perfusionist

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Herzchirurgische Klinik an der LMU Herzklinik am Augustinum KLINIKUM DER UNIVERSITT MNCHEN transport equipment content emergency trolley: v-a cannulas in all sizes Seldinger guide wire, ACT messurement, material, etc. technical requirements 24/7 out-side use

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Herzchirurgische Klinik an der LMU Herzklinik am Augustinum KLINIKUM DER UNIVERSITT MNCHEN upward4 G foreward16 G sideward8 G downward20 G backward1.5 G specifications of grafity load direction european aviation savety agency EASA, www.easa.europa.euwww.easa.europa.eu Heart Lung Renal Assist

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The clinic to go.

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V-V ECMO in hypoxemic or hypercapnic respiratory failure V-A ECMO in right ventricular failure or profound hypoxemia Awake ECMO preferred when possible Comfort oriented cannulation (e.g. Avalon cannula) Choice of ECMO procedure in potential Ltx pts

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WHEN? Bridge to Lung Transplant Refractory hypercapnic and/or hypoxic respiratory failure: paCO 2 >80 mmHg and/or PaO 2 /FiO 2