Chris Bishop

@ri-science.bsky.social

Wonderful day on Saturday at the Royal Institution representing C4TS @qmul.bsky.social for their “For your inspiration: Medical Marvels” event. Great to showcase our cutting edge research and innovation in translational trauma sciences #Publicengagement #Trauma #Science #ECMO #Coagulopathy #MedSky

Just hanging with my gorgeous girl #cavachon #cavachonpuppy #Millie

🚨 Webinar alert!🚨

Come and join me for this exciting #CPDme webinar “Extracorporeal Life Support - From the operating theatre to the streets”
I’ll be taking a deep dive into ECLS from it’s beginnings in cardiac surgery, to contemporary applications in PHEM, EM and trauma www.cpdme.com/webinar

#MedSky #ResusSky #ECMOSky #CritCareSky

Great day teaching on the Prehospital Medicine iBSc “Special Circumstances” practical day up on the 🚁 pad at London’s Air Ambulance. Fantastic engagement from students and faculty as we tackled resuscitative ECMO and simulated special circumstances in resuscitation! #ECMO #ECPR #Cardiacarrest #CPR

An absolutely fascinating 2 days at the Institute of Prehospital Care’s Resus Science Symposium. Eye opening experiences from Patients, clinicians and scientist all sharing in the goal of pushing patient care forward.

Welcome Millie! #Cavachon #Cavachonpuppy #Dogsofsky

LV energetics in pts on #ECPR achieving ROSC
🫀invasive left heart catheterization + 3D echocardiography
🫀high VA #ECMO flow significantly reduced LVEDP, LVEDV, LVSW vs low flow, irrespective of survival status:
🩺 6 survivors; they had higher LVEF + lower LVEDV/LVEDP at lowest EBF
🔗 bit.ly/4gKByxp

Addressing the inequity/postcode lottery of community CPR and PAD deployment is a good place to start.

Undoubtedly though, the future is encouraging for the advancement of resuscitation science and medicine. We have just got to get it right - doing the best thing for the patient; meaningful interventions with honourable intentions. End

As an ECLS enthusiast myself, I can appreciate the wave of excitement that these potential developments may bring - indeed, we are now asking “in who, how and when do we offer ECPR?”, whereas a few years ago the question was framed “does ECPR work?” 6/

Disposition and ECMO centre buy-in exceptionally important here. These patients need managing within a system that is highly skilled and experienced in looking after VA ECMO patients. Clinical course can be very turbulent and unpredictable, with many complications to be mitigated 5/

VA ECMO patients (as they are, post ECPR cannulation) are incredibly sick, with complicated physiology (underlying disease and ECLS interactions) with a relatively high mortality 4/

Adding in the human factors, logistical and environmental challenges that PHEM/PHC brings, coupled with the time criticality of minimising the low-flow times (because seconds count in ECPR!) 3/

It must be appreciated that ‘putting the patient on pump’ is only the first step. PH ECPR patients a world apart (in complexity terms)from elective VV and (some) VA in a relatively controlled operating theatre or cath lab environment with time on your side 2/

Very thoughtful and nuanced post from @garethgrier1.bsky.social on the huge complexities of potentially delivering extracorporeal CPR (ECPR) across the U.K. There is much enthusiasm and pockets of excellence - but a whole system-wide change is needed. Like REBOA and RT, a HALO procedure (1/2)

Almost time for a birthday tipple!! 🎂 🥂 🎈 🎁 #DecemberBirthday #SantasLittleHelper

In peripheral VA #ECMO, LV filling pressures estimation with Doppler techniques (E/A, E/é) can be challenging or unreliable due to low transmitral flow and myocardial activation resulting in several TDI peaks

European Heart Journal - Cardiovascular Imaging (2024) 25, e296–e311

St.Emlyn's Emergency Medicine blog and podcast. Team of emergency medicine and critical care specialists working to improve the education of clinicians and the care of patients.

Check out the @stemlyns.bsky.social podcast I recorded at Tactical Trauma 24 in Sundsvall - VA ECMO in trauma, plus a glimpse into potential future endovascular resuscitation therapies in severe injury! www.stemlynsblog.org #MedSky #CritCareSky #ECMOSky #ECLS #ECMO #Trauma #PHEM #EM #Surgery

Really looking forward to it! #LTC2024

Awesome trip to 🇫🇷 for #ParisRescue - this time around as faculty! Awesome to meet, teach and socialise with #ECPR and #ECMO enthusiasts from around the 🌍! #MedSky #EMSky #CritCareSky #ECMOSky

🫀Emergency preservation and resuscitation (EPR) via cold aortic flush of crystalloid to get the 🧠 temp down to 10 oC may buy time for DCS in patients where 🕰️ runs out (long transport times, prolonged ischaemia, exsanguination) - watch this space…the future is now!

🫀 We are still learning, and there is still much to unpick in terms of CV dysfunction following major trauma haemorrhage
🫀Selective aortic arch perfusion (SAAP) may be a useful bridge to ROSC, or as intermediary step between REBOA and full extracorporeal support

🫀 VA ECMO useful rescue strategy for a ‘cardiogenic’ phenotype of shock in trauma (⬇️ CO, ⬆️ SVRI, ⬇️ SVO2)
🫀Discuss the patient early…and ensure major haemorrhage controlled
🫀 Overall survival to discharge/transfer 35-40% for trauma VA ECMO - comparable to non-trauma cohorts

🧠 Consider coronary hypoperfusion in addition to severe metabolic derangements (⬆️ K, ⬇️ Ca ⬇️ pH driving CV failure in trauma shock
🫀 CV failure can occur even in the absence of a direct cardiothoracic injury
🫀Consider PA catheter +/- TOE to guide resuscitation

Great to present on trauma VA ECMO for @rcem.bsky.social Cambridge Trauma Futures! My top take homes:
🫀Significant proportion of highly injured patients are now reaching hospital alive, with incredibly deranged physiology

Greetings!

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