ECMO

ECMO Inclusion Criteria 
  • Age < 75
  • Witnessed Arrest
  • No Asystole as initial rhythm
  • Bystander CPR within 10 minutes of arrest
  • Total CPR < 60 minutes
  • No DNR/Terminal Condition
ECMO CPT Codes/Billing 
  • Procedure: ECMO initiation CPT 33947
  • PROCEDURE: ECMO CANNULA INSERTION, PERCUTANEOUS (CPT 33952)
  • Indication: Refractory cardiopulmonary arrest
  • Consent: Implied
  • Details: The previously inserted left femoral vein sheath (9F) was addressed and sterile-prepped. Under sterile conditions, A 145cm Amplatz guidewire was inserted into through sheath and into the left femoral vein. The 9F sheath was removed. The vessels underwent serial dilation. A 21F multi-stage venous ECMO cannula was successfully placed into the left femoral vein after estimated the length of insertion (measured externally) to 35cm. The cannula was clamped and cleared of clot. The cannula was sutures into place using 6 0-silk suture.  A biopatch was placed and the cannula was dressed.
  • Complications: none
Procedure: Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; initiation, veno-arterial  (CPT 33947)
Indication: Cardiopulmonary Arrest refractory to traditional resuscitation
Consent: Implied
Details: ECMO cannulae were inserted by Doctors [xxxx] and [xxxx].   The circuit was closed by underwater seal under my supervision. Care was taken to avoid any air in the circuit.  The patient was given 5000 units of Heparin prior to initiation.  The RPMs were increased to 1500rpm.  The final clamp was released.  ECMO pump flow was increased to [3.0 L/min] with RPMs taken to [2500 rpm]. The venous cannula appeared dark and the arterial cannula appeared bright red.  Initial sweep gas rate was set to: [5] liters/min with Sweep Fi02 of 100%. Post procedural arterial line showed a MAP of [65]mmHg, with a goal MAP > 65mmHg.  Vasopressors: [norepinephrine gtt was started at 10 micrograms/min ].  [2] liters of normal saline were given.  Serial arterial blood gas results will guide further adjustments.
Complications: [none]

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