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Mechanical Circulatory Support

title: Mechanical Cardiac Assist Devices tags: #FFICM #cardiac #mechanical_cardiac_support notebook: 🌑-FFICM type: anki

Mechanical Cardiogenic Support Therapies

In terms of additional L/min of cardiac output

0-1 = [[IABP]] 1-2 = Impella (multiple versions of impella) 2-3 = Impella, TandemHeart, VAECMO 3-4 = Impella, TandemHeart, VAECMO 4-5 = Impella, TandemHeart, VAECMO 5-7 = VAECMO 1

Flashcard type:basic
In supplementing cardiac output, how many L/min can an IABP assist with? 0-1 L/min
In supplementing cardiac output, how many L/min can an Impella assist with? 1-5 L/min
In supplementing cardiac output, how many L/min can a TandemHeart assist with? 2-5L/min
In supplementing cardiac output, how many L/min can an ecmo (VA) circuit assist with? 2-7 L/min
The three main brands of VADS to know are Impella
TandemHeart
HeartMate

Flashcard type:cloze
The order of cardiac support and L/min provided goes:
{{c1::IABP::device}} - {{c1::0-1::flow}}
{{c2::Impella::device}} - {{c2::1-5::flow}}
{{c3::TandemHeart::device}} - {{c3::2-5::flow}}
{{c4::VAECMO::device}} - {{c4::2-7::flow}}

Mechanical devices can be as a bridge to recovery, palliation, heart transplant, or durable long term device. 1

VA-ECMO

Heart-Lung Bypass machine. Deoxygenated blood pulled from venous circulation by cannula (18-21 french) and pump. Blood passes through pump into oxygenator and gas exchange occues. Blood returns via cannula to arterial (14-16 french) curculation using a centrifugal pump. There can also be a "distal perfusion catheter" returning some blood to a cannulated leg (reducing risk of critical limb ischaemia) 1

Flashcard type:basic
What size cannulae is the venous (intake) cannula on VA ECMO 18-21 french (~6-7mm)
What size cannulae is the arterial cannula on VA ECMO 14-16 french (~4-5mm)
What type of pump is an ECMO circuit? A "centrifugal pump"

Centrifugal pumps used now, previously roller pumps used. Centrifugal cause less damage to blood then roller. 1

Oxygenator is a "hollow fibre membrane" 1

Cannulation percutaneously. 1

Patients with potentially reversible causes (myocarditis/graft failure) do better than post surgery or ACS patients. Patients receiving ECPR in cardiac arrest have v poor prognosis. 1

Evidence around it:

Extracorporeal Life Support Organisation Registry (87,000 patients) - >12000 patients with VA-ECMO. Hospital Mortality Rates 50-60%, 6 Month Survival 30%. 1

Flashcard type:basic
In the CESAR trial, what was the treatment modality studied? ARDS Specialist Units with capacity for ECMO
In the CESAR trial, what was the treatment outcome used? 6 month survuval without severe disability
In the CESAR trial, what was the disease studied? Patients with ARDS
In the CESAR trial, what year was it published? 2009
In the CESAR trial, what was used to give the definition of severe respiratory failure? Murray score > 3
In the CESAR trial, which groups of patients (pathology wise) with respiratory failure were excluded? Patients who'd had Peak Insp Pressures > 30 or FiO2 > 80 for more than a week.
In the CESAR trial, which groups of patients (age wise) with respiratory failure were excluded? Over 65
Which has a higher risk of VTE, VA or VV ECMO? VA ECMO
Which has a lower risk of VTE, VA or VV ECMO? VV ECMO
Which pathology for adults has the best rates of survival in VV-ECMO? Non Necrotising Vial Pneumonia
Which is the main UK trial looking at ECMO in ARDS from 2009? The CESAR trial

Above questions are from: [[mcqs-and-sbas-in-intensive-care-medicine-oxford-higher-special-training]]

  1. Mechanical Circulatory Support Devices for Cardiogenic Shock: State of the Art. Ludhmila Abrahao Hajjar and Jean-Louis Teboul ↩↩↩↩↩↩↩↩

  2. Ventricular assist devices. Paul Harris. Lakshminarasimhan Kuppurao ↩

  3. Principles of intra-aortic balloon pump counterpulsation ↩

  4. The normal IABP waveform ↩