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Methods of Anesthesia I > Cardiac Assist Devices > Flashcards

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 arresting 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

cannula for venovenous ECMO

A

outer lumen for drain blood to ECMO

inner lumen infuses blood back into RA

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8
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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9
Q

when is VA ECMO indicated?

A

cardiac and respiratory failure

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10
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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11
Q

disadvantage to VA ECMO (compared to VV ECMO) 3

A

1- non pulsatile perfusion
2- potentially less oxygen to coronary arteries
3- higher chance of emboli entering arterial circulation

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12
Q

why is there potentially less oxygen to coronary arteries in VA ECMO?

A

because oxygen supply is better when it enters from the heart rather than machine

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13
Q

Ventricular Assist Device (VAD)

A

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

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14
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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15
Q

how does VAD increase CO?

A

helps heart pump

improves hearts own ability to pump by relieving fluid overload

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16
Q

what are VAD meant to be a bridge for?

A

heart transplant, they have risk of clotting and stroke

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17
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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18
Q

long term intracorporeal VAD

A

long term use in pt with permanent HF

insertion with open heart surg and bypass

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19
Q

internal catheter VAD other name

A

impella cardiac assist device

20
Q

how does internal catheter VAD work?

A

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

21
Q

extracorporeal VAD other name

A

tandem heart

22
Q

when is tandem heart indicated

A

acute HF when weakened from recent heart surgery

23
Q

extracorporeal VAD how does it work

A

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

24
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
Electromagnetic interference can alter function
more susceptible to infection
chest compression controversial
25
Q

why do we need an aline for people with VADs?

A

flow is nonpulsatile thus NIBP are inaccurate

26
Q

what should the MAP be at for people with VAD?

A

60mmHg

27
Q

why are VAD pts usually on anticoagulants

A

pumps cause hemolysis and thrombolytic events

28
Q

what causes electromagnetic interference?

A

bipolar cautery is preferred

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

29
Q

why are chest compressions controversial in VAD pts

A

can dislodge cannulas and lead to immediate death

OR will die without compressions

30
Q

4 anesthetic considerations for pt with VAD

A

identify and talk to VAD team
secure a power source for VAD
establish safe coagulation plan with surgeon and cardiologist
hemodynamic stability crucial

31
Q

what is the VAD team composed of?

A

cardiac surgeons, nurses, perfusionists etc

32
Q

What information do you need from the VAD team?

A

pump speed and flow

rpm and L/min

33
Q

How long do VAD batteries last?

A

6 hr

34
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

35
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**
36
Q

intra aortic balloon pump

A

balloon inserted into aorta via femoral artery

attached to console that triggers inflation and deflation

37
Q

when does the IABP balloon inflate?

A

dichrotic notch of aline or t wave of ECG

38
Q

when does the IABP balloon deflate

A

at or prior to R wave

39
Q

what things can trigger balloon inflation?

A

ECG
aline waveform
pacemaker

40
Q

benefit of balloon inflation

A

diastole,
increases diastolic pressure
increases Coronary perfusion pressure

41
Q

benefit of ballon deflation

A

systole
sucks blood forward
decrease afterload and oxygen demand
increases CO

42
Q

how much can a IABP increase CO by?

A

40%

43
Q

when is IABP indicated?

A

cardiogenic shock
acute heart attack
difficulty weaning off bypass

44
Q

c pulse heart pump

A

extra aortic balloon pump
“permanent”
epicardial sensing leads attached to LV

45
Q

benefits of C pulse heart pump

A 
placed thoracotomy (not sternotomy)
no anticoagulants bc external to vasculature
46
Q

when does the balloon inflate c pulse pump? benefit?

A

diastole
increase coronary blood flow
increases CO (second pulse)

47
Q

when does the balloon deflate c pulse pump? benefit?

A

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

Methods of Anesthesia I (10 decks)

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