IABP
AUTOTRANSFUSION
EVERYTHING VADS
POTPOURRI
ECMO Cannulation and Types
General ECMO
100
During a femoral artery insertion of the IAB, this is proper placement of the IAB tip.
What is: Just distal to the left subclavian artery or between 2nd and 3rd intercostal space.
100
The amount of heparin to be added to one liter of NS to prepare anticoagulant solution for ATS cases.
What is 15,000 units.
100
What do BTR and BTT stand for?
BTR: Bridge to recovery
BBT: Bridge to transplant
100
What does eCCO2R stand for?
Extracorporeal carbon dioxide removal
100
True or false: In order for central cannulation, the chest needs to remain open.
True
100
What are three complications of ECMO?
Bleeding, hemorrhage, stroke (air or clots), SIRS, kidney injury (or failure), hemolysis, infections, neurologic injury
200
This determines the correct catheter size.
What is the height of the patient?
200
In a centrifugal ATS bowl, when blood components separate, red blood cells comprised this layer of the bowl.
What is the outermost layer?
200
What are two common complications of VAD use/ support?
Stoke (embolized clot), infections, bleeding, hemolysis, arrhythmias
200
A correctly timed IAB shows inflation at this event.
What is the dicrotic notch?
200
Type of ECMO used for ARF
VV (veno-venous ecmo)
200
What does "chugging" mean during ECMO, and what are the two possible causes?
The vessel or RA collapsing around the drainage cannula, either because of malposition, hypovolemia, or both.
300
Inflation of the IAB increases myocardial oxygen supply by increasing these two events.
What is diastolic augmentation and coronary artery perfusion?
300
When separating blood components via centrifugation for platelet rich plasma, these components comprise the center layer.
What are platelets and buffy coat?
300
What is "Ecpella", and why would one use it?
ECMO + Impella-- ECMO for systemic support, and Impella to unload the LV
300
Reduction of the power expenditure of the ventricle when on an LVAD is referred to as...
(LV) unloading)
300
This type and location of cannulation requires a DLP.
Femoral VA ECMO
300
What is the appropriate RPM to establish ECMO flows, and why?
1800-2000 to overcome the initial afterload of the patient
400
The primary effects of IABP counterpulsation are (2 answers)
What is decrease myocardial oxygen demand and increase myocardial oxygen supply?
400
The time in which processed ATS blood must be reinfused.
What is 6 hours from processing?
400
What is an example of a centrifugal VAD?
Heartmate III, Heartware
400
What year was the first successful ECMO? Hint: It was on a neonate
1975
400
Type of ECMO for failure to wean from cardiopulmonary bypass
VA (veno-arterial) ECMO
400
Regarding ECMO, what does "delta P" describe?
Change in pressure between the "PreOxy" pressure and "PostOxy" pressure to describe the resistance (and therefore the presumed clot) within the oxygenator.
500
The preferred trigger while using IABP.
What is ECG?
500
To form platelet gel, this is required to activate the platelet rich plasma (2 items).
What are thrombin and calcium chloride?
500
This VAD drains blood flow from the LA via an external pump, and reinfuses it to the femoral artery
The TandemHeart
500
For a standard Sechrist blender, what is the range of FiO2 and sweep gas?
21-100% FiO2, and 0-10 LPM sweep (with the potential of an extra LPM for a total of 11 LPM)
500
The surgeon wants to this VV ECMO patient to be able to be ambulated in the ICU. What cannulation strategy would you recommend?
Neck cannulation, with a dual-lumen cannula
500
You put a respiratory failure patient on ECMO. The drainage cannula and the reinfusion cannula are both bright red. What are your next steps, and why?
Check the pulse oximetry of the patient, draw a patient VBG, PreOxy gas, Post oxy gas to calculate recirculation. Concern for recirculation >20%
600
Regarding IAB timing, there is an increase in LV afterload AND a decrease in cardiac output.
What is early inflation?
600
This is the minimum micron size for ATS blood reinfusion filter.
What is 40 microns?
600
What is an example of an axial flow VAD??
Heartmate II, Impella
600
This was the first commercially available autotransfusion device.
What is the Bentley ATS 100?
600
This cannulation strategy provides both pulmonary and cardiac support, but divides the inflow between the venous side and the arterial side.
VAV
600
How might you put a second oxygenator within an ECMO circuit when your patient is on a high EMCO flow, such as 5 LPM?
Parallel (as opposed to series)
700
Regarding IAB timing, minimal diastolic augmentation, lack of reduction in myocardial oxygen demand and LV afterload.
What is early delfation?
700
A contraindication to using ATS, Floseal (or any hemostatic agent) causes this.
What is platelet aggregation/clot formation?
700
What is a difference between the Impella 5.5 and the Impella CP?
Higher flow capabilities with the 5.5 (up to 5.5LPM versus 4.3 LPM)
5.5 is implanted surgically through the axillary artery, whereas the CP is percutaneous
5.5 is typically longer term VAD support, CP is typically shorter term/ rescue
700
What was name of the commonly referenced trial that showed that ECMO shows advantages over conventional ventilatory support for severe respiratory failure?
CESAR (Conventional ventilatory support vs. Extracorporeal membrane oxygenation for Severe Adult Respiratory failure)
700
Clot in the right heart mobilized and wedged in a distal pulmonary artery. Which type of ECMO would be more appropriate?
What is VV ECMO
700
When on ECMO, what is the appropriate therapeutic ACT, aPTT, and Anti-Xa?
ACT, goal is typically 180- 220 sec
aPTT goal is 1.5-2.5 x baseline (40 to 80 seconds)
Anti-Xa goal is 0.3-0.7 IU/ mL