IABPs, LVADs, and ECMO

Question 1

The IABP improves the balance between myocardial oxygen _______ and _______

Answer 1

supply and demand

Question 2

Indications for IABP

Answer 2

-Cardiogenic shock
-Myocardial infarction
-Intractable angina
-Difficult separation from cardiopulmonary bypass

Question 3

Contraindications for IABP

Answer 3

-Severe aortic insufficiency
-Descending aortic disease
-severe PVD
-Sepsis

Question 4

IABP balloon is inserted through the ______ ______ and advanced along the ______ _____

Answer 4

-femoral artery
-descending aorta

Question 5

the tip of the balloon should be positioned ___cm distal to the ______ _______ artery.

Answer 5

-2 cm
-left subclavian artery

Question 6

IABP: proper position is confirmed with ____, _____, or ____.

Answer 6

CXR, fluoroscopy, or TEE

Question 7

When does the IABP inflate?

Answer 7

When the aortic valve closes at the beginning of diastole

Question 8

_______ correlates with the dicrotic notch on the aortic pressure waveform.

Answer 8

Inflation

Question 9

The balloon deflates just before the onset of ______.
This correlates with the ____ wave on the EKG.

Answer 9

systole
R wave

Question 10

Balloon ______ causes a vacuum-like effect that reduces _______ and reduces _____ _____ work. This reduces myocardial ______ _____.

Answer 10

deflation
afterload
left ventricular work
oxygen demand

Question 11

Most common complications of IABP:

Answer 11

vascular injury, infection at site
thrombocytopenia

Question 12

LVAD pump flow is highly dependent on ….. (3)

Answer 12

-adequate LV preload
-pump speed (RPMs)
-pressure gradient across the pump (afterload)

Question 13

Most common cause of death with LVAD

Answer 13

Sepsis

Question 14

Common complication with LVAD:

Answer 14

GI bleeding

Question 15

Fluid administration would increase ____ and reduce ______ _______

Answer 15

-increase preload
-reduce pump speed

Question 16

VV ECMO return cannula:

Answer 16

R side of heart

Question 17

VA ECMO return cannula:

Answer 17

L side of heart

Question 18

Preferred method for respiratory failure who’s cardiac function is intact:

Answer 18

VV ECMO
-allows lungs to recover

Question 19

VA ECMO used for:

Answer 19

cardiogenic shock with associated respiratory failure and/or hemodyanamic failure

Flows 3-6 L/min

Question 20

ECMO complications

Answer 20

Bleeding → anticoagulation necessary to prevent clot formation in circuit
Thromboembolic event → DVT, stroke
Infection secondary to cannula sites
Limb ischemia
Multiorgan dysfunction
Coronary or cerebral hypoxia, air emboli
GI bleed

Question 21

Pharmacokinetics of IV medications altered due to ________ ______.

Answer 21

membrane oxygenator

Question 22

VAD- Heartmate 3 =

Answer 22

pulsatile

Question 23

VAD- Heartware =

Answer 23

continuous

Question 24

What is vital for a VAD?

Answer 24

volume status

Question 25

VAD: Prevent ________ and maintain sympathetic tone during induction and emergence

Answer 25

bradycardia

Question 26

30% of LVAD patients develop some form of ___ __________.

Answer 26

RV dysfunction

Question 27

Associated RV dysfunction treatment

Answer 27

Inotropes → epinephrine, milrinone to decrease RV afterload Inhaled nitric oxide → pulmonary vascular dilation to decrease pulmonary hypertension and RV workload

Question 28

What kind of patients receive LVADs?

Answer 28

Bridge to Transplant: patients listed for heart transplant, but need a VAD until transplant Destination Therapy: patients that do not meet the criteria for transplant at time

Question 29

LVAD BP Goal (MAP)

Answer 29

Goal 60-80 mmHg

Question 30

Pulse Ox

Answer 30

difficult to obtain d/t lack of pulsatile flow

Question 31

Goal INR w/ LVAD

Answer 31

2-3

Question 32

Driveline is?

Answer 32

Connects controller/power to LVAD. Comes out of abdomen

Question 33

Absolutely NO _____!

Answer 33

MRIs Implanted VAD is all metal