IABPs, LVADs, and ECMO Flashcards

1
Q

The IABP improves the balance between myocardial oxygen _______ and _______

A

supply and demand

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2
Q

Indications for IABP

A

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

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3
Q

Contraindications for IABP

A

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

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4
Q

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

A

-femoral artery
-descending aorta

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5
Q

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

A

-2 cm
-left subclavian artery

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6
Q

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

A

CXR, fluoroscopy, or TEE

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7
Q

When does the IABP inflate?

A

When the aortic valve closes at the beginning of diastole

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8
Q

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

A

Inflation

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9
Q

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

A

systole
R wave

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10
Q

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

A

deflation
afterload
left ventricular work
oxygen demand

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11
Q

Most common complications of IABP:

A

vascular injury, infection at site
thrombocytopenia

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12
Q

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

A

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

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13
Q

Most common cause of death with LVAD

A

Sepsis

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14
Q

Common complication with LVAD:

A

GI bleeding

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15
Q

Fluid administration would increase ____ and reduce ______ _______

A

-increase preload
-reduce pump speed

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16
Q

VV ECMO return cannula:

A

R side of heart

17
Q

VA ECMO return cannula:

A

L side of heart

18
Q

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

A

VV ECMO
-allows lungs to recover

19
Q

VA ECMO used for:

A

cardiogenic shock with associated respiratory failure and/or hemodyanamic failure

Flows 3-6 L/min

20
Q

ECMO complications

A

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

21
Q

Pharmacokinetics of IV medications altered due to ________ ______.

A

membrane oxygenator

22
Q

VAD- Heartmate 3 =

A

pulsatile

23
Q

VAD- Heartware =

A

continuous

24
Q

What is vital for a VAD?

A

volume status

25
Q

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

A

bradycardia

26
Q

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

A

RV dysfunction

27
Q

Associated RV dysfunction treatment

A

Inotropes → epinephrine, milrinone to decrease RV afterload

Inhaled nitric oxide → pulmonary vascular dilation to decrease pulmonary hypertension and
RV workload

28
Q

What kind of patients receive LVADs?

A

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

29
Q

LVAD BP Goal (MAP)

A

Goal 60-80 mmHg

30
Q

Pulse Ox

A

difficult to obtain d/t lack of pulsatile flow

31
Q

Goal INR w/ LVAD

A

2-3

32
Q

Driveline is?

A

Connects controller/power to LVAD. Comes out of abdomen

33
Q

Absolutely NO _____!

A

MRIs

Implanted VAD is all metal

34
Q
A