ECMO buys time — but only if we choose the right patient, the right configuration and a clear destination. In this masterclass we cover the ECMO circuit, choosing veno-venous versus veno-arterial support (and hybrid V-A-V configurations), indications and contraindications, the SAVE and RESP scores, ultrasound-guided cannulation and the distal perfusion cannula, daily circuit management (flows, pressures, pre- and post-oxygenator gases, right radial monitoring and Harlequin syndrome), left ventricular distension and unloading with IABP or Impella (ECPELLA), anticoagulation with unfractionated heparin guided by anti-Xa levels, bivalirudin for HIT, DAPT in freshly stented patients, transfusion and haemolysis monitoring, sedation and antibiotic pharmacokinetics on the circuit, vasopressors and inotropes, weaning (flow-reduction trials with echo criteria for VA-ECMO and sweep-off trials for VV-ECMO), bridge to LVAD or transplant, palliative care, and care after decannulation — illustrated with a fulminant myocarditis case and the evidence from ECLS-SHOCK, CULPRIT-SHOCK, DanGer Shock, CESAR, EOLIA, ARREST, Prague OHCA and INCEPTION.

Guest: Dr. A M Thirugnanam, MD, MSICP, FSCAI, Ph.D., Senior Interventional Cardiologist, author, educator and founder of the Academy of Elite Doctors.

Host: Alexander Wood

Cardiology Course FM is the station for doctors, students, nurses and everyone who looks after the heart.

Learn more:

• Cardiology books: https://cardiologybooks.com

• Mentorship with the Academy of Elite Doctors: https://academyofelitedoctors.com

• Online cardiology courses: https://cardiologycourse.com

• World Elite Doctors: https://worldelitedoctors.com

For medical education only. This episode is not a substitute for individual medical advice.