Extracorporeal membrane oxygenation or ECMO is one of those treatments we sometimes need to think about with our very sick patients. I recently had to make a referral to my local centre and doing so made me wonder what it is that the ECMO centres want from us to make the path smoother. So I asked Dr Susan Dashey, Consultant at Glenfield Hospital and Dr Brij Patel, Consultant at the Royal Brompton and Harefield Hospitals. Both these are centres for ECMO.
I think their answers will provide us with some guidance for the future.
The video below will also serve as a useful guide.
Tom, one of my colleagues from the Critical Care Outreach Team and I discuss this paper and its findings reaching our own conclusions. Deferring Arterial Catheterisation in Patients with Septic Shock.
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We return to our 48-year-old patient: jaundiced, hypotensive, drowsy, and bleeding. In decompensated cirrhosis, every treatment targets a disrupted system — splanchnic vasodilation, portal hypertension, toxin accumulation, and renal hypoperfusion.Although these patients look fluid overloaded, they are effectively hypovolaemic. Start with small aliquots of balanced crystalloid, avoiding 0.9% saline. In hepatorenal syndrome or tense ascites, 20% albumin is
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In this episode, I walk through the real-world critical care management of acute decompensated alcohol-related liver disease, using a high-risk ICU case to anchor the discussion. The focus is on understanding the underlying physiology—portal hypertension, rebalanced haemostasis, hepatic encephalopathy, infection, and hepatorenal syndrome—and translating that physiology into clear first-hour priorities at the bedside. Listeners are
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