EDECMO 106: Working in the CT ICU with Mark Ramzy
What happens when emergency medicine, cardiac surgery, critical care, ECMO, and human factors collide in the highest-stakes environment imaginable? Mark Ramzy takes us inside the CTICU to explore the art of resuscitation—and why knowing when to move fast, when to slow down, and how to work as a team may matter as much as the technology itself.. In this episode of ED ECMO, Zack Shinar sits down with Mark Ramzy, an emergency medicine–trained cardiothoracic intensivist, to explore what resuscitation looks like when the patient is already surrounded by ECMO, LVADs, invasive hemodynamic monitoring, recent sternotomy, and a highly specialized multidisciplinary team. Mark shares practical lessons from the CTICU, including how post-cardiac-surgery arrest algorithms differ from traditional ED resuscitation, when to shock rather than immediately perform chest compressions, how to recognize impending deterioration, and why knowing when to “speed up” and when to “slow down” can make all the difference. He discusses open-chest resuscitation, internal cardiac massage, VA ECMO as an exit strategy, and his experience with double sequential defibrillation. The conversation then moves beyond procedures into the human factors of high-stakes medicine. Mark describes working alongside cardiothoracic surgeons, interventional cardiologists, intensivists, nurses, respiratory therapists, and emergency physicians—and argues that successful ECPR depends less on territorial boundaries and more on recognizing what each member of the team brings to the table. Finally, Mark offers a cautionary perspective on the rapid expansion of ECMO and ECPR. As these technologies become increasingly accessible, he emphasizes the importance of quality control, mentorship, humility, and developing strong relationships across specialties. His overarching message is simple: medicine is a team sport, and the best resuscitation teams know not only what they can do, but when to listen, when to slow down, and when to let someone else lead.