Patient & Pathophysiology
This type of shock occurs when the heart cannot pump enough blood to meet the body's needs.
What is cardiogenic shock?
This catheter-based micro-axial flow pump moves blood from the LV into the ascending aorta.
What is Impella?
In a traditional percutaneous approach, the IABP is commonly introduced through which artery?
What is the femoral artery? Other approaches may be used in selected circumstances.
This major complication occurs when blood cells are damaged as they pass through a mechanical circulatory support device.
What is hemolysis?
This device provides counterpulsation rather than continuous direct pumping of blood from the LV into the aorta.
What is the IABP?
This ECMO configuration primarily supports gas exchange in patients with severe respiratory failure without directly providing circulatory support.
What is VV-ECMO?
This device inflates during diastole and deflates before systole to provide counterpulsation.
What is the intra-aortic balloon pump (IABP)?
Which imaging modality is commonly used to assess Impella position and ventricular function at the bedside?
What is echocardiography?
A patient on IABP develops a cool, pale leg with diminished distal pulses. Which complication must be urgently evaluated?
What is limb ischemia?
Which support configuration is generally used when the primary problem is severe respiratory failure without a need for direct circulatory support?
What is VV-ECMO, if the patient meets selection criteria?
A patient has severe RV dysfunction, elevated right-sided filling pressures, and poor forward flow. Which failing chamber should be a major focus of assessment?
What is the right ventricle?
This Impella model can provide up to approximately 5.5 L/min of flow and is used for temporary LV support.
What is Impella 5.5?
What is a common surgical access route for Impella 5.5 implantation?
What is the axillary artery? The exact approach depends on the patient and institutional practice.
A patient on Impella develops low-flow alarms. Name two potential causes to assess rather than assuming the pump itself has failed.
Possible causes include low preload/hypovolemia, malposition, RV failure, or suction events. Any two are acceptable.
This device is positioned across the aortic valve to unload the LV and move blood into the aorta.
What is Impella?
A patient with severe ARDS remains profoundly hypoxemic despite optimal conventional management. Which ECMO configuration may be considered if the patient is an appropriate candidate?
What is VV-ECMO?
What is the key difference between VV-ECMO and VA-ECMO in the type of support provided?
VV-ECMO primarily supports gas exchange; VA-ECMO supports gas exchange and circulation.
After femoral IABP placement, which bedside assessment helps identify possible vascular compromise?
Assess distal limb perfusion, including pulses or Doppler signals, color, temperature, and changes from baseline.
A patient on VA-ECMO develops pulmonary edema and LV distension. What cardiac loading problem should the team recognize?
Increased LV afterload with inadequate LV ejection or unloading.
Name one major reason a patient might need VA-ECMO rather than VV-ECMO.
Significant circulatory failure requiring circulatory support, in addition to any respiratory support needed.
A patient in refractory cardiogenic shock has severe hypoxemia and circulatory failure. Which ECMO configuration may address both problems, and what important limitation should be assessed?
What is VA-ECMO? It provides circulatory support and gas exchange, but increases LV afterload and may contribute to LV distension; monitoring and patient selection are essential.
A patient has severe isolated LV pump failure and needs temporary LV unloading and forward flow. Name one device that may be considered and explain why ejection fraction alone is not enough to select a device.
Impella 5.5 may be considered to unload the LV and provide forward flow. Selection also depends on shock severity, RV function, anatomy, vascular access, contraindications, and treatment goals.
Name three domains that should be repeatedly evaluated to determine whether mechanical circulatory support is achieving its intended effect.
Perfusion/hemodynamics, oxygenation/ventilation, and end-organ function.
A patient on VV-ECMO becomes hypoxemic despite apparently adequate circuit flow. Name two possible explanations that require clinical assessment.
Possible explanations include recirculation, inadequate effective ECMO flow relative to cardiac output, impaired native lung gas exchange, increased oxygen consumption, or cannula-position problems. Any two are acceptable.
A patient has cardiogenic shock, severe RV dysfunction, and refractory hypoxemia. Name two potential support strategies the multidisciplinary team could evaluate and one factor that would influence the choice.
Potential strategies may include VA-ECMO or a tailored combination of circulatory and respiratory support. Choice depends on hemodynamics, RV/LV function, oxygenation, anatomy, contraindications, reversibility, and treatment goals.