MCS Flashcards

1
Q

Correct position for IABP

A

Tip should be 2cm distal to the L SCA ostium

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2
Q

IABP indications and contraindications

A

Indications:
- Acute cardiogenic shock
- Prior to high-risk CABG/PCI
- Inability to separate from CPB
- Unstable angina

Contraindications:
- AR
- Aortic aneurysm or dissection
- Severe sepsis
- Severe atherosclerosis
- Severe coagulopathy
- Severe PAD

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3
Q

What gas is used to inflate the IABP?

A

Helium

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4
Q

Functions of the IABP

A

“Counter-pulsatoin”

  • Increase myocardial oxygen supply during diastole
  • Decrease afterload during systole
  • Decreased LVEDP and wall tension
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5
Q

Which VV-ECMO configuration is most likely to have recirculation?

A

Fem-RIJ configuration

  • Look for brighter blood in drainage cannula (femoral cannula)
  • Paradoxical decrease in systemic oxygenation with increased ECMO flows
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6
Q

What are the options for managing North-South syndrome?

A
  • Decrease inotropes
  • Optimize ventilation
  • Increase ECMO flows
  • VAV ECMO
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7
Q

Positive predictive values for weaning from VA-ECMO

A

At minimal ECMO flows (1-1.5L/min):

  • LVOT VTI >10
  • LVEF >20-35%
  • lateral mitral annulus TDI >6cm/s
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8
Q

What type of drugs have the highest sequestration in the ECMO circuit?

A

Highly lipid soluble drugs

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9
Q

Goal aPTT and HAL on VA-ECMO

A

aPTT: 60-80
HAL: 0.3-0.7

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