test 7 neurosurgery; venous thromboembolism, angioVac, trauma, and portable circulatory systems

Question 1

Neurosurgery

Answer 1

 Currently, CPB indicated for patients with giant basilar and cerebral aneurysms
 Hypothermia with circulatory arrest allows the only chance of surgical repair in this group

Question 2

Neurosurgery technique

Answer 2

 Fem-fem bypass typically employed
 TEE used to verify cannulation and assess cardiac structures (ie. AI)
 Typical circulatory arrest times average ~20minutes
 No X-C or cardioplegia used in these cases
 Monitoring of LV filling pressures to prevent distension, especially if fibrillation occurs, is necessary
 Mortality rates of 20-25%

Question 3

3rd leading cause in cardiovascular mortality

Answer 3

• Venous Thromboembolism (VTE)

Question 4

Considerations for AngioVac Procedure

Answer 4

 V-V bypass
 Anticoagulation
 Patient volume
         Hypervolemia
 Size of cannula
 Emboli filter
 Cannula obstruction
 Venacava filter
 P A emboli
 Hybrid room-Cath Lab
         C-Arm
         Lead

Question 5

Thoracic Trauma: Cardiac wounds

Answer 5

 Penetrating wounds such as gunshot or stab wounds.
 Typically repaired w/o CPB except where septum, valves, or coronaries have been severely impacted
 Sustained systemic wounds may be contraindication to heparinization and use of CPB

Question 6

Thoracic Trauma: Aortic Injury

Answer 6

 High rate of mortality when acute aortic injuries occur
 Small wounds may be repaired, but large wounds and those involving the arch are often repaired under CPB and possibly DHCA
 Descending thoracic aorta repairs involve left heart bypass

Question 7

CPB in the Emergency Room challenges and solutions

Answer 7

Procedures in ED
 Education of ED Staff
 Attitude of Perfusionists
- fix by training and using CardioHelp

Question 8

Portable Circulatory Systems

Answer 8

• To maximize outcomes, CPS (and other ECC) should be instituted by supervision of a board certified cardiothoracic surgeon with a qualified perfusionist present