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Fa: Methods 2 > 2. Cardiac Assist Devices > Flashcards

2. Cardiac Assist Devices Flashcards

1
Q

ECMO

A

pt being put on bypass that is not having cardiac surgery

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2
Q

is the heart arrested and cross clamp placed during ECMO?

A

no

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3
Q

what is the purpose of ECMO

A

keep pt alive during ACUTE cardiac or respiratory failure

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4
Q

venovenous (VV) ECMO

A

drawn from right side of heart
oxygenated by ECMO
returned to right side of heart

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5
Q

when is VV ECMO indicated?

A

respiratory failure

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6
Q

can you use VV ECMO for a pt with cardiac failure

A

no

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7
Q

VV ECMO cannula and locations

A

double lumen cannula in RA

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8
Q

cannula for venovenous ECMO

A

outer lumen for drain blood to ECMO
inner lumen infused oxygenated blood from ECMO into RA

inner lumen infuses blood back into RA

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9
Q

Venoarterial (VA) ECMO

A

blood removed from right heart
oxygenated by ECMO
returned to left side of heart via arterial cannula

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10
Q

when is VA ECMO indicated?

A

cardiac and respiratory failure

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11
Q

what is the advantage of VA ECMO compared to VV ECMO

A

VA can be used in cardiac failure

oxygenation improved pulm vasculature and decrease pulm HTN then heart failure resolves

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12
Q

disadvantage to VA ECMO (compared to VV ECMO) 4

A

1- non pulsatile perfusion
2- requires venous and arterial cannulation
3- higher risk of AKI
4- higher chance of emboli entering arterial circulation

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13
Q

what % of pts develop AKI on VA ECMO

A

92%

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14
Q

Ventricular Assist Device (VAD)

A

artificial heart placed in pt with heart failure to help ventricle pump

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15
Q

how does VAD work? 3

A

1 tubing placed inside ventricle
2- tubing withdraws some blood into a pump
3- pumps back into body through reinfusion tube

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16
Q

how does VAD increase CO?

A
  • helps heart pump
  • improves heart ability to pump by relieving fluid overload/stretching ventricle

improves hearts own ability to pump by relieving fluid overload

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17
Q

LVAD

A

support LHF
- withdraws blood out of LV and pump into aorta

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18
Q

LVAD purpose

A

bridge to heart transplant

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19
Q

LVAD risk

A

clotting
stroke
RHF from interventricular septum shift LEFT

(not a long term solution)

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20
Q

RVAD

A

supports RHF after LVAD
- blood out of RV
- pumps into pulm artery

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21
Q

is an LVAD or RVAD placed first?

A

LVAD is placed first (neg effects on RV)

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22
Q

can a pt have an LVAD and an RVAD?

A

yes - RVAD can be placed after existing LVAD

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23
Q

what are the three types of VADs?

A

1-long term intracorporeal VAD
(pump and tubing in body)
2- short term intracorporeal VAD (catheter)
3- short term extracorporeal VAD (tubing inside with pump outside)

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24
Q

long term intracorporeal VAD Indication

A

permanent HF and no transplant available

insertion with open heart surg and bypass

25
Q

long term intracorperal VAD placement

A

open heart surgyer w/bypass

26
Q

internal catheter VAD other name

A

impella cardiac assist device

27
Q

how does internal catheter VAD work?

A

small pump in LV that removes blood from LV and pumps to aorta

28
Q

where does the proximal part of the impella VAD sit?

A

in the aorta

29
Q

extracorporeal VAD other name

A

tandem heart

30
Q

when is tandem heart indicated

A

acute HF when weakened from recent heart surgery
short term use

31
Q

extracorporeal VAD how does it work

A

venous catheter inserted in femoral vein into RA then LA via hole in interarterial septum
draws oxygenated blood out to VAD
pumps back in via arterial cannula in femoral artery

32
Q

extracorporeal VAD insertion location

A

groin into femoral vein

33
Q

anesthetic implications for pt with VAD undergoing non cardiac surgery (6)

A 
a line required
MAP used to trend BP
usually on anticoagulants
RSI indicated (full stomach)
Electromagnetic interference can alter function
more susceptible to infection
chest compression controversial
34
Q

why do we need an aline for people with VADs?

A

flow is nonpulsatile (no systolic/diastolic)
– NIBP are inaccurate

35
Q

what should the MAP be at for people with VAD?

A

60mmHg

36
Q

why are VAD pts usually on anticoagulants

A

pumps cause hemolysis and thrombolytic events

37
Q

what causes electromagnetic interference?

A

bipolar cautery is preferred

if monopolar must be used then place grounding pad away from VAD

38
Q

why are chest compressions controversial in VAD pts

A

can dislodge cannulas and lead to immediate death

OR will die without compressions

39
Q

4 anesthetic considerations for pt with VAD

A

identify and talk to VAD team
secure a power source for VAD
use pump speed (RPM) and flow (L/min) from VAD team
establish safe coagulation plan with surgeon and cardiologist
hemodynamic stability crucial

40
Q

what is the VAD team composed of?

A

cardiac surgeons, nurses, perfusionists etc

41
Q

What information do you need from the VAD team?

A

pump speed and flow

rpm and L/min

42
Q

How long do VAD batteries last?

A

6 hr

43
Q

what is included in coagulation plan for VAD pts?

A

get coagulation labs (PT, PTT, INR)

pts on warfarin should switch to heparin before elective surgery

44
Q

what coags are pts with VAD normally on?

A

warfarin
- discontinue and bridge with heparin

45
Q

what two things do you need to be cautious of VAD patients with hemodynamic stability?

A 
maintain preload (pump flow decrease when preload decrease)
avoid hypertension (decreases output of device when afterload is increased)
**blood can pool in heart and cause thrombi**
46
Q

intra aortic balloon pump

A

balloon inserted into aorta via femoral artery

attached to console that triggers inflation and deflation

47
Q

when does the IABP balloon inflate?

A

onset of diastole:
dichrotic notch of aline or t wave of ECG

48
Q

when does the IABP balloon deflate

A

systole:
at or prior to R wave

49
Q

what things can trigger balloon inflation?

A

ECG
aline waveform
pacemaker

50
Q

benefit of balloon inflation

A

(diastole)
increases diastolic pressure
increases Coronary perfusion pressure
increases O2 supply

51
Q

benefit of ballon deflation

A

(systole)
sucks blood forward
decrease afterload
decrease oxygen demand
increases CO

52
Q

how much can a IABP increase CO by?

A

40%

53
Q

when is IABP indicated?

A

acute HF :
* cardiogenic shock
* acute heart attack
* difficulty weaning off bypass

54
Q

the IABP is a type of

A

temporary LVAD

55
Q

c pulse heart pump

A

extra aortic balloon pump (outside aorta)
Squeezes aorta from outside
“permanent”
epicardial sensing leads attached to LV

56
Q

benefits of C pulse heart pump

A 
placed thoracotomy (not sternotomy)
no anticoagulants bc external to vasculature
57
Q

when does the balloon inflate c pulse pump? benefit?

A

diastole
increase coronary blood flow
increases CO (second pulse)

58
Q

when does the balloon deflate c pulse pump? benefit?

A

prior to systole (detection of R wave)
decrease afterload
increases CO

Fa: Methods 2 (15 decks)

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