#cardiotwitter #ACCFIT Let's simplify temporary mechanical support!

Slides from Dr. Hussain's talk at #CVBootcamp2020

Think:
💡Is MCS choice appropriate for clinical scenario?
💡Understand and frequently monitor connections & hemodynamics
💡Understand potential complications
Intra-aortic balloon pump

💡Diastolic augmentation, ⬆️ MAP during augmented beat
💡⬇️ afterload and end-diastolic pressure
💡CO augmentation 0.7-1.4 l/min
💡Position: IABP tip at carina level on CXR
Intra-aortic balloon pumpDiastolic augmentation, MAP during augmented beat afterload and end-diastolic pressureCO augmentation 0.7-1.4 l/minPosition: IABP tip at carina level on CXR
Intra-aortic balloon pumpDiastolic augmentation, MAP during augmented beat afterload and end-diastolic pressureCO augmentation 0.7-1.4 l/minPosition: IABP tip at carina level on CXR
Intra-aortic balloon pumpDiastolic augmentation, MAP during augmented beat afterload and end-diastolic pressureCO augmentation 0.7-1.4 l/minPosition: IABP tip at carina level on CXR
Intra-aortic balloon pumpDiastolic augmentation, MAP during augmented beat afterload and end-diastolic pressureCO augmentation 0.7-1.4 l/minPosition: IABP tip at carina level on CXR
Impella

💡⬆️ MAP, afterload
💡⬇️ LVEDP
💡CO augmentation >> compared to IABP
💡Pre-load dependent and afterload sensitive!
💡Position: Mid-inlet ~ 3.5 cm from AV on TTE
Impella MAP, afterload LVEDPCO augmentation >> compared to IABPPre-load dependent and afterload sensitive!Position: Mid-inlet ~ 3.5 cm from AV on TTE
Impella MAP, afterload LVEDPCO augmentation >> compared to IABPPre-load dependent and afterload sensitive!Position: Mid-inlet ~ 3.5 cm from AV on TTE
Impella MAP, afterload LVEDPCO augmentation >> compared to IABPPre-load dependent and afterload sensitive!Position: Mid-inlet ~ 3.5 cm from AV on TTE
Impella MAP, afterload LVEDPCO augmentation >> compared to IABPPre-load dependent and afterload sensitive!Position: Mid-inlet ~ 3.5 cm from AV on TTE
VA ECMO

💡Replaces ❤️ & 🫁
💡Adjust FiO2: ⬆️ oxygenation
💡Adjust sweep speed: ⬆️ ventilation
💡Watershed area: Where blood pumped by native ❤️ mixes with ECMO blood - matters where ABG is drawn from
💡⬆️ afterload - must ensure LV vented and AV opening to avoid catastrophe!
VA ECMOReplaces & Adjust FiO2: oxygenationAdjust sweep speed: ventilationWatershed area: Where blood pumped by native mixes with ECMO blood - matters where ABG is drawn from afterload - must ensure LV vented and AV opening to avoid catastrophe!
VA ECMOReplaces & Adjust FiO2: oxygenationAdjust sweep speed: ventilationWatershed area: Where blood pumped by native mixes with ECMO blood - matters where ABG is drawn from afterload - must ensure LV vented and AV opening to avoid catastrophe!
VA ECMOReplaces & Adjust FiO2: oxygenationAdjust sweep speed: ventilationWatershed area: Where blood pumped by native mixes with ECMO blood - matters where ABG is drawn from afterload - must ensure LV vented and AV opening to avoid catastrophe!
VA ECMOReplaces & Adjust FiO2: oxygenationAdjust sweep speed: ventilationWatershed area: Where blood pumped by native mixes with ECMO blood - matters where ABG is drawn from afterload - must ensure LV vented and AV opening to avoid catastrophe!
MCS experts: If I am missing something important, please add to this in the comments!
You can follow @athakkarMD.
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