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Methods of Anesthesia > Cardiac Assist Devices > Flashcards

Cardiac Assist Devices Flashcards

1
Q

Pt being placed on bypass in times where pt is not in heart surgery

A

ECMO

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2
Q

Purpose of ECMO

A

Keep patients alive during acute cardiac or respiratory failure

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3
Q

What is venovenous ECMO?

A
  1. indicated only for respiratory failure
  2. blood drawn from R side
  3. Oxygenated by ECMO
  4. Returned to R side of heart
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4
Q

Cannula for VV ECMO

A

Double lumen in R atrium

  1. Outer lumen drains the heart and sends deoxygenated blood to ECMO
  2. Inner lumen infuses oxygenated blood from ECMO intro R atrium
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5
Q

What is venoarterial ECMO?

A
  1. Used for cardiac and respiratory failure
  2. Blood withdrawn from R side of heart
  3. Oxygenated by ECMO
  4. Returned to L side of heart via arterial cannula
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6
Q

Advantage of VA ECMO compared to VV

A
  1. VA supports the heart AND lungs, and can be used in cardiac failure
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7
Q

Disadvantage of VA compared to VV ECMO

A
  1. Non-pulsatile perfusion
  2. Potentially less oxygen delivery to the coronary arteries
  3. Higher chance of emboli entering arterial circulation
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8
Q

What is a VAD?

A

-Artificial heart, placed in pts with HF to help the ventricle pump blood

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9
Q

How does the VAD work?

A
  1. Tubing is placed inside the ventricle
  2. Tubing withdraws blood from ventricle into pump
  3. Pump pumps some blood to body through “reinfusion” tube
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10
Q

Benefits of VAD

A

Increases CO, leading to less fluid overload/edema

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11
Q

How does VAD increase cardiac output?

A
  1. Helps heart pump blood

2. Improves hearts ability to pump blood bc it relieves fluid overload and stretching of ventricle

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12
Q

What does a LVAD do?

A

Supports L heart failure by withdrawing blood out of L ventricle and pumping it into the aorta

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13
Q

What are LVADs meant for?

A

As a bridge to a heart transplant

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14
Q

Why are LVADs not meant to be a long term solution?

A

They carry a risk of clotting and stroke

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15
Q

What does a RVAD do?

A

Supports R HF by withdrawing blood out of the R ventricle and pumping it into the pulmonary artery

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16
Q

Long term VAD

A

Intracorporeal VAD

17
Q

Short term VADs

A
  • Intracorporeal VAD/catheter VAD

- Extracorporeal VAD

18
Q

When is a long term intracorporeal VAD indicated?

A

In patients with “permanent” HF when no transplant is available

19
Q

How is a long term intracorporeal VAD placed?

A

Open heart surgery and CPB

20
Q

How does the Impella VAD work?

A
  1. Catheter inserted into femoral artery, guided through aorta into L ventricle
  2. Small pump at tip of catheter sitting in L ventricle
  3. Pump removes blood from LV and pumps it to proximal part of catheter in aorta
21
Q

When is the extracorporeal (Tandem heart) indicated?

A

For short term use, acute HF, when heart becomes weakened after recent surgery

22
Q

How does the Tandem Heart work?

A
  1. Venous catheter inserted into femoral vein into R atrium, then L atrium
  2. Catheter draws oxygenated blood out of L atrium and sends it to extracorporeal VAD
  3. Tandem heart pumps blood to body through arterial catheter in femoral artery
23
Q

Anesthetic implications for pts with VADs

A
  1. A-line required
  2. MAP is used to trend BP (at least 60mmHg)
  3. Anticoagulants
  4. Full stomach, RSI indicated
  5. Electromagnetic interference (EMI) can alter device function
  6. More susceptible to infection
  7. Chest compressions are controversial
24
Q

Considerations for pts with VAD

A
  1. Identify and talk to VAD team
  2. Secure reliable power source for VAD
  3. Establish safe coagulation plan with surgeon and cardiologist
  4. Maintain preload (avoid hypovolemia) and avoid hypertension for crucial hemodynamic stability
25
Q

How is an intra-aortic balloon pump inserted?

A

Through the femoral artery, attached to external console which triggers inflation during diastole and deflation during systole

26
Q

With the IABP, the balloon should ideally inflate

A

During the dichrotic notch of the arterial line waveform or the T wave of the ECG
-during diastole

27
Q

With the IABP, the balloon should ideally deflate

A

At or just prior to the R wave on the ECG

-during systole

28
Q

IABP inflation may be triggered by:

A
  1. ECG
  2. Arterial line waveform
  3. Pacemaker
29
Q

Benefits of IABP during inflation

A
  • during diastole, pushes blood back into aorta
  • Increases DBP
  • Increases CPP/increases O2 supply
30
Q

Benefits of IABP during deflation

A
  • During systole, sucks blood forward
  • Decreases afterload and O2 demand
  • Increases CO by up to 40%
31
Q

Indication for IABP

A
  • Any type of acute HF:
    1. Cardiogenic shock
    2. Acute heart attack
    3. difficulty weaning off bypass
32
Q

What is a C-pulse heart pump?

A
  • Extra-aortic balloon pump to allow permanent balloon pump

- Alternative to open LVAD placement

33
Q

Attached to L ventricle in C pulse heart pump

A

Epicardial sensing leads

34
Q

How is a C-pulse heart pump placed

A

Via thoracotomy

35
Q

Are patients required to be on anticoagulants with a C-pulse heart pump?

A

No bc the balloon is external to the vascular system

36
Q

What happens with balloon inflation in the C-pulse heart pump?

A

Inflates during diastole

  • Inc coronary blood flow/O2 supply
  • Inc CO
37
Q

What happens with balloon deflation in C-pulse heart pump?

A

Deflates prior to systole, upon detection of the R wave

  • decreases afterload (and O2 demand)
  • Increases CO

Methods of Anesthesia (20 decks)

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