Cardiac Assist Device

Question 1

What is ECMO?

Answer 1

Question 2

What is Venovenous (VV) ECMO?

Answer 2

Question 3

Explain the Cannula For Venovenous ECMO

Answer 3

Question 4

Location of cannulas for Venoarterial (VA) ECMO

Answer 4

Question 5

Advantage of VA ECMO

(When Compared to VV ECMO)

Answer 5

Question 6

Disadvantages of VA ECMO

(When Compared to VV ECMO)

Answer 6

Question 7

What The Heck Is A Ventricular Assist Device (VAD)?

Answer 7

Question 8

Benefits Of A Ventricular Assist Device?

Answer 8

Question 9

Main indication for Ventricular Assist Devices (VADs)

Answer 9

Question 10

Three different Types of VADs

Answer 10

Question 11

Indication for Long Term Intracorporeal VAD?

Answer 11

Question 12

What is a Internal Catheter VAD?

(Impella Cardiac Assist Device)

Answer 12

Question 13

How does an Internal Catheter VAD work?

Answer 13

Question 14

What is an Extracorporeal VAD (Tandem Heart)?

Answer 14

Question 15

How does Extracorporeal VAD (Tandem Heart) work?

Answer 15

Question 16

Anesthetic Implications For Patients With VADs (7)

Answer 16

1. Arterial line is required
2. MAP is commonly used to trend blood pressures
   - MAP should be AT LEAST 60mmHg
3. Patients are usually on anticoagulants
4. Patients are considered full stomach, and an RSI is indicated
5. Electromagnetic Interference (EMI) can alter device function
   - Bipolar cautery is more likely to be used
6. Patients are more susceptible to infection due to the direct route from the driveline to the body
7. Chest compressions are controversial
   - Some say it can dislodge the device, others say it is needed because the patient will not survive otherwise

Question 17

Anesthetic considerations for a VAD Monitor

Answer 17

1. Identify and talk to the VAD team! (if the hospital has one)
2. Secure a reliable power source for the VAD
3. Establish a safe coagulation plan with the surgeon & cardiologist
4. Hemodynamic stability is crucial
   - 4a. Maintain preload (avoid hypovolemia), because pump flow decreases when preload decreases
   - 4b. Avoid hypertension, because increases in afterload can cause a decrease in the output of the device

Question 18

What is an Intra-Aortic Balloon Pump (IABP)?

Answer 18

Question 19

At what points does the Intra-Aortic Balloon Pump (IABP) inflate/deflate?

Answer 19

Question 20

What can trigger the Intra-Aortic Balloon Pump (IABP)?

Answer 20

Question 21

What are the Benefits of the Intra-Aortic Balloon Pump during inflation/deflation?

Answer 21

Question 22

Indication for the Intra-Aortic Balloon Pump

Answer 22

Question 23

What is a C-Pulse Heart Pump?

Answer 23

Question 24

What is unique about the C-Pulse Heart Pump?

Answer 24

Question 25

When does the C-Pulse Heart Pump inflate/deflate?

Answer 25