MCS Flashcards
Correct position for IABP
Tip should be 2cm distal to the L SCA ostium
IABP indications and contraindications
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
What gas is used to inflate the IABP?
Helium
Functions of the IABP
“Counter-pulsatoin”
- Increase myocardial oxygen supply during diastole
- Decrease afterload during systole
- Decreased LVEDP and wall tension
Which VV-ECMO configuration is most likely to have recirculation?
Fem-RIJ configuration
- Look for brighter blood in drainage cannula (femoral cannula)
- Paradoxical decrease in systemic oxygenation with increased ECMO flows
What are the options for managing North-South syndrome?
- Decrease inotropes
- Optimize ventilation
- Increase ECMO flows
- VAV ECMO
Positive predictive values for weaning from VA-ECMO
At minimal ECMO flows (1-1.5L/min):
- LVOT VTI >10
- LVEF >20-35%
- lateral mitral annulus TDI >6cm/s
What type of drugs have the highest sequestration in the ECMO circuit?
Highly lipid soluble drugs
Goal aPTT and HAL on VA-ECMO
aPTT: 60-80
HAL: 0.3-0.7