Cardiac Surgery Concepts Flashcards
(198 cards)
1
Q
Procedure that restores normal blood flow to an area of the heart by creating new routes around obstructive coronary arteries
A
Coronary Artery Bypass Graft (CABG)
2
Q
Explain the steps of a CABG
A
- Blood vessel(s) from the body are removed (harvested)
- Harvested vessels (grafts) are sewn proximal and distal to an atherosclerotic coronary artery
- Blood now flows through the harvested vessel and “bypasses” the blocked coronary artery
3
Q
What blood vessels can be harvested for a CABG?
A
- Saphenous vein
- Left internal mammary artery (LIMA)
- Radial artery
4
Q
Where is the proximal anastomosis in a CABG?
A
On the aorta
5
Q
Where is the distal anastomosis in a CABG?
A
On the coronary artery, distal to the obstruction
6
Q
What anastomosis does the surgery typically sew on first?
A
Distal (coronary artery)
7
Q
The LIMA only requires a (proximal/distal) anastomosis?
A
Distal
8
Q
Most commonly used graft for CABG
A
Left Internal Mammary Artery (LIMA)
9
Q
Where is LIMA usually anastomosed?
A
With the LAD
10
Q
Why are arterial grafts preferred over venous grafts for CABG?
A
Coronary arterial pressure will damage the saphenous endothelium more quickly, leading to a reocclusion rate at 10 years for venous grafts of ~60%
11
Q
Types of Percutaneous Coronary Intervention (PCI)
A
Balloon angioplasty and cardiac stenting
12
Q
Alternative to CABG, less invasive, used for less severe cases of CAD
A
Cardiac stenting
13
Q
Tends to show better 5 year survival and patency rates, but carries a higher risk of stroke at 5 years
A
CABG
14
Q
Summary of cardiopulmonary bypass (CPB) machine
A
-Functions as both heart and lung by draining deoxygenated blood from the body, oxygenating it and removing CO2, then pumps oxygenated blood back into the body
15
Q
Purpose of the cardiopulmonary bypass machine (reasons to use it)
A
-When the heart needs to be stopped or empty
16
Q
Why would you want to drain blood from the heart?
A
If you need to open it to expose a valve for open valve repair
17
Q
True/false: the heart has to be arrested for heart surgery
A
False. It is not mandatory in all situations
18
Q
Why would a surgeon stop the heart for surgery if it is not necessary?
A
It is easier to operate on a non-moving target
19
Q
When is the heart commonly arrested?
A
When a patient goes on CPB, although it is not required
20
Q
Solution used to arrest the heart
A
Cardioplegia
21
Q
Components of cardioplegia
A
Potassium rich solution with glucose, magnesium, calcium, bicarb, buffers and free radical scavengers (Mannitol)
22
Q
Can cardioplegia be injected with blood?
A
Yes, cardioplegia can be mixed and injected with blood
23
Q
Most common way of arresting the heart
A
Antegrade cardioplegia via the aortic root
24
Q
What is antegrade cardioplegia?
A
- Injecting cardioplegia (CP) into the coronary arteries through the coronary os
- Can be into the aortic root through a cardioplegia cannula or direct cannulation of the coronary os
25
How is CP injected into the aortic root?
- A cross clamp is placed on the ascending aorta to keep the CP from washing out into the body
- Injected through a cardioplegia cannula
26
How can the heart get sufficient oxygen in cases where 1. an ascending aortic cross clamp is placed or 2. the heart needs to be arrested
Cardioplegia lines bc they can also infuse blood into the coronary arteries
27
Where is retrograde CP injected?
Coronary sinus
28
How do you prevent coronary sinus damage with retrograde CP?
Measure the pressure within the coronary sinus as CP is injected so it does not rupture
29
When is retrograde CP used?
For aortic valve replacement
30
How is pressure monitored with retrograde cardioplegia?
1. The surgeon throws sterile, non-compliant tubing over the drape
2. Anesthetist hooks tubing to either CVP or PAP stopcock on triple transducer
3. When the heart is arrested, stopcock is turned off to the patient and open to the retrograde line
31
Why can't you hook up retrograde cardioplegia monitoring to the A-line transducer?
You need to measure the A-line during bypass
32
True/false: You can measure CVP/PAP while monitoring retrograde cardioplegia
False
33
What stopcock position can measure CVP/PAP?
To the side
34
What stopcock position can measure retrograde cardioplegia pressure?
Up (toward the patient)
35
Indications for retrograde CP
1. Arrests areas of the heart distal to high grade obstructions
2. Where antegrade CP would easily wash out (ascending aorta repair, open aortic valve repair)
36
Describe the CPB machine circuit
1. De-oxygenated blood is drawn away from the heart through a venous cannula
2. Venous blood is stored in a venous reservoir
3. The venous blood is sent through an oxygenator, heat exchanger and arterial filter
4/5. Oxygenated blood is reinfused into the body via a "main pump" that pumps the blood into the aorta through an arterial cannula
6. An aortic cross clamp is usually placed on the ascending aorta
37
Where is the venous cannula is usually placed?
In the R atrium
38
Where can the venous cannula be placed?
R atrium
SVC/IVC
Femoral vein
39
What does the venous reservoir do?
Stores a surplus of blood and helps remove any air that inadvertently entered the bypass circuit
40
What is the purpose of the aortic cross clamp?
1. Prevent blood from the arterial cannula from backing up into the heart
2. Allow the heart to stay arrested by keeping the injected cardioplegia in the heart
41
What are the components of the bypass machine? (9)
1. Venous cannula(s)
2. Venous reservoir
3. Main pump
4. Oxygenator
5. Heat exchanger
6. Arterial filter
7. Arterial cannula
8. Ultrafilter
9. Cell salvage suction (cardiotomy suction, cell saver suction and left ventricular vent)
42
When can you NOT use a venous cannula in the R atrium?
During R sided heart operations bc it wouldn't prevent blood from gushing out of the surgical site or keep air from being sucked in
43
Where would a venous cannula be placed in the traditional open R sided heart operation?
In the superior and inferior vena cavas
44
How do you place a venous cannula without opening the chest?
Through the femoral vein, threaded up into the R atrium
45
How can an arterial cannula be placed without opening the chest?
Through the femoral artery, threaded up in the aorta
46
When is femoral arterial and venous cannulation particularly useful?
When CPB must be initiated emergently
47
2 primary purposes of the venous reservoir in CPB
1. The venous cannula can remove any air that inadvertently enters the venous drainage line
2. The venous reservoir also stores a surplus of blood in the bypass circuit
48
Main pump options
1. Non-pulsatile (more common, uses centrifugal pump)
| 2. Pulsatile (newer, "roller" or "diagonal" pump
49
Purpose of the main pump in CPB
Pumps blood to the body via the arterial cannula via pulsatile or non-pulsatile flow
50
Advantages of pulsatile flow
Perfusion is better because it is more physiologic
51
Disadvantages of pulsatile flow
1. Difficult for perfusionist
| 2. More damage to blood elements
52
Purpose of the heat exchanger in CPB
Cools and heats blood to control temperature of the pt
53
Modest hypthermia temperature
34 C
54
Purpose of modest hypothermia
34 C implemented while the pt is on CPB for organ protection
55
Advantages of modest hypothermia
1. Decreases O2 requirements
| 2. Decreases anesthetic requirements
56
A decrease in body temperature 1C decreases cerebral O2 consumption by ___%
5%
57
A decrease in body temperature 10C decreases cerebral O2 consumption by ___%
50%
58
Disadvantages of hypothermia
1. Increases the chances of coagulopathy (increases bleeding risk)
2. Increases blood viscocity, which can decrease perfusion
59
Role of the oxygenator in CPB
1. Oxygenates the blood
2. Removes CO2
3. Site of volatile agent entry into the bypass machine
60
2 types of oxygenators in CPB
1. Bubble oxygenator
| 2. Membrane oxygenator
61
Advantages and disadvantages of bubble oxygenators in CPB
1. Simple and lower cost
2. More trauma to the blood
3. Rarely used
62
Advantages and disadvantages of membrane oxygenators in CPB
1. Less blood trauma
2. Increased complexity and cost
3. Standard oxygenator used today
63
Biggest problem with the oxygenator
Damages the blood
64
Role of the arterial filter in CPB
Removes fat globules and air bubbles from the bypass circuit
65
Role of the ultrafilter in CPB
Sometimes added to the circuit to remove excess water and electrolytes from the circulating volume, concentrating the blood in a pt with undesirably low hematocrit
66
Why would you want to use an ultrafilter in CPB?
To concentrate blood in a pt with an undesirably low hematocrit
67
Types of suction used in CPB
1. Standard (regular OR suction)
| 2. Blood salvage suction (cardiotomy suction, cell saver suction, left ventricular vent)
68
Suctioned blood that will eventually be returned to the patient in CPB
Blood salvage suction
69
Advantage of blood salvage suction in CPB
Decreases the chances of the pt needing a donor transfusion
70
In CPB, takes blood from the field and returns it to a "cardiotomy reservoir" before ultimately ending up in the venous reservoir
Cardiotomy suction
71
When is cardiotomy suction used in CPB
After the pt is heparinized while the pt is on the bypass machine
72
Advantage of cardiotomy suction
1. It is whole blood, so it includes clotting factors, platelets and PRBCs
73
Disadvantages of cardiotomy suction
1. Blood going through is damaged by the bypass machine, therefore is associated with a more pronounced systemic inflammatory response and coagulopathy
2. Significant contributor to the hemolysis and particulate emboli that occurs during CPB
74
In CPB, suctioned blood from the field is washed and centrifuged, which separates RBCs from the plasma, platelets and particulate matter. RBCs are moved to an infusion bag and transfused back to the patient
Cell saver
75
Hematocrit of cell saver blood
50-70%
76
Advantages of cell saver
1. Particles such as fat, air and tissue are filtered out of the blood
2. Blood is less damaged when it gets returned to the patient
77
Disadvantages of cell saver
1. It is NOT whole blood
| 2. Takes longer before it can be reinfused into the patient
78
Removes all venous blood that was not picked up by the venous reservoir (blood from bronchial and Thebesian veins)
Left ventricular vent
79
Where is the left ventricular vent inserted?
Into the left ventricle through the pulmonary vein
80
Risk of using left ventricular vent
Air embolism
81
Aortic cross clamp location
Proximal to the arterial cannula on the ascending aorta
82
Why does the aortic cross clamp need to be placed proximal to the arterial cannula?
So perfusion to the head and rest of the body is possible
83
What would happen if you placed the aortic clamp prior to bypass on a beating heart full of blood?
The patient would die right away from either a massive heart attack or a ruptured aorta
84
What is the sequence for arresting the heart and going on bypass?
1. Drain the blood from the heart via the venous cannula
2. Place the aortic cross clamp (while the heart is still beating)
3. Arrest the heart by injecting cardioplegia
85
When is it okay to clamp the aorta while the heart is beating?
If the heart is drained of blood on bypass
86
When can the heart be arrested without a clamp?
If the surgeon uses retrograde cardioplegia OR directly cannulates the coronary arteries for cardioplegia
87
Advantages of the aortic cross clamp
1. Easier to arrest the heart (keeps CP in)
2. Prevents air inside the heart from entering circulation
3. Prevents re-infused blood (from arterial cannula) from backing up into the heart
88
Disadvantages of aortic cross clamp
1. Physiologic perfusion to the heart is not possible
| 2. Increases risk of stroke from a possible dislodging emboli
89
Purpose of partial aortic cross clamp
Allows a hole to be made in the aorta for a graft to be sewn without blood shooting out everywhere
90
Disadvantage of partial aortic cross clamp
Associated with emboli and stroke
91
When is cardiopulmonary bypass necessary?
When the heart needs to be emptied of blood or the heart is going to be arrested
92
Advantages of bypass
1. The surgery is "easier" for the surgeon
| 2. There is more hemodynamic stability
93
Disadvantages of CPB
1. Priming fluid causes hemodilution (Hct decreases)
2. An aortic cross clamp is usually placed, which can lead to emboli
3. May be difficult coming off the pump (re-establish an effective heart beat and contractility)
4. Pulmonary complications are more likely
5. Tissue perfusion is less effective
6. The patient's blood gets damaged by the bypass machine
7. Large volume shifts can occur
94
How much fluid is used to prime the bypass machine
2000 ml
95
Potential contents of priming fluid
Heparin, bicarb, mannitol, colloid and possibly steroids or antifibrinolytic agents
96
Why might bypass machines need to be primed with some blood in pediatrics?
Peds blood volume is small and priming with some blood can prevent over-dilution
97
What is an open bypass sytem?
- more common
- venous drainage freely flows by gravity into a venous reservoir that is open to the atmosphere
- Any air is naturally vented (good), but blood is in direct contact with air (bad)
98
What is a closed bypass system?
Either the venous reservoir has been removed from the system or it is in the system but closed to the atmosphere
99
Is the collapsible bag configuration considered open or closed bypass, and why?
Closed because the blood in the bag is not exposed to room air
100
Is the hardshell reservoir considered open or closed bypass, and why?
Open because the blood in the reservoir is exposed to surrounding air
101
What is the primary perfusion system to CPB?
Open
102
What is the priming volume for the mini cardiopulmonary bypass?
600 ml
103
Is mini CPB open or closed?
Closed
104
Components of the mini CPB
1. Pump
2. Oxygenator
3. Reduced tubing length
4. Arterial filter (usually)
105
What components are missing in the mini CPB?
1. Venous reservoir
2. Cardiotomy suction
3. Heat exchanger
106
Advantages of mini CPB
1. All advantages of a closed bypass system
2. May improve myocardial protection
3. Associated with less blood transfusion
4. Associated with earlier recovery times and reduced ICU/total hospitalization time
107
Disadvantages of mini CPB
1. Demanding for the perfusionist
| 2. May not be beneficial (minimal effect on inflammation and coagulation)
108
How do you limit the motion of the heart while it is beating and being operated on? (off pump surgery)
Suction clamps are applied
109
Downside to off pump heart surgery
Suction clamps can cause significant hypotension and/or arrhythmias
110
Draining part of the venous blood from the patient's body while the rest of the blood stays in the heart and travels to the body
Partial cardiopulmonary bypass
111
How does partial CPB work?
Some blood is removed from the R atrium through the venous cannula. The blood goes through the bypass machine and perfuses the body through the arterial cannula
Some blood stays in the heart and goes to the lungs before being pumped into the L ventricle and out the aorta
112
Why would a patient be put on partial bypass?
If the patient cannot tolerate the procedure off pump
113
What are 2 options if a surgeon cannot do a procedure off pump because the patient cannot tolerate it?
1. Place pt on full bypass (non-physiologic perfusion)
| 2. Place pt on partial bypass (physiologic perfusion)
114
True/false: Partial flow through the arterial cannula in partial CPB is enough to prevent hypotension
True
115
Implications of partial CPB
1. Heart must stay beating
2. Blood that stays in the heart needs to pick up volatile agent and be oxygenated/ventilated
3. No need for an ascending aortic clamp
116
How does the L heart partial bypass work?
1. Blood travels through the R heart and lungs as normal
2. Some blood is removed from the L atrium through a "venous" cannula, travels to bypass and perfuses lower extremities through the arterial cannula
3. Some blood stays in L atrium and goes out the aorta to perfuse the head
117
Implications of L heart partial bypass
1. Only the L heart is bypassed
2. All blood flowing to bypass is oxygenated
3. Heart must stay beating and lungs must stay ventilated
118
What is not needed in the bypass machine on L heart partial bypass?
Oxygenator, reservoir or heat exchanger
119
Indication for L heart partial bypass
Open descending thoracic aortic aneurysm repair
120
Advantages of L heart bypass
1. Heart stays beating and does not need to be restarted (physiologic perfusion)
2. Lower circuit prime volume leads to:
- Less hemodilution
- Less blood damaged
- Less heparinization needed (target ACT 150-200s)
3. Lower chances of postop renal failure
4. Blood pressure can be controlled by perfusionist
5. No direct blood-air contact in the circuit
121
Disadvantages of L heart bypass
1. No blood or fluid can be added to the bypass system (no reservoir)
2. The pt cannot be actively warmed or cooled
3. Systemic air embolization is more likely without the reservoir
122
How does R heart bypass work?
- Venous cannulas from SVC and IVC remove deoxygenated blood from the R side of the heart and send it to bypass
- Blood is reinfused into the pulmonary artery through an arterial cannula, which is distal to a cross clamp on the pulmonary artery
- Blood from the machine goes to the lungs
- The heart stays beating and the lungs are ventilated
123
Why is it okay for the heart to pump against the clamp in R heart bypass?
The heart is empty
124
Indications for R heart bypass
1. Tricuspid valve repair
2. Pulmonic valve repair
3. R ventricular assist device
125
Advantages to the R heart bypass
1. Does not stop the heart
2. Does not need to clamp the aorta
3. Does not need the oxygenator
126
Disadvantages of the R heart bypass
Same as the L heart bypass
127
How do you repair aortic aneurysms without clamping?
1. Add another perfusion cannula (retrograde cerebral perfusion or antegrade cerebral perfusion)
2. Make the patient so cold that their metabolic requirements would be low enough to survive a short period of time with no perfusion (DHCA-deep hypothermic circulatory arrest)
128
What is DHCA?
Deep hypothermic circulatory arrest; the perfusionist puts the patient on bypass, makes the patient profoundly hypothermic and then turns the bypass off
129
Indications for DHCA
1. Ascending aorta repair
2. Aortic arch repair
3. Descending aorta repair
4. Clipping of certain complex brain aneurysms
130
How does DHCA work (detailed)
1. Patient is on CPB, heat exchanger decreases patient's temperature
2. The heart is arrested, circulation through bypass is slowed to a near standstill
3. The profound decrease in O2 consumption allows the patient to survive with minimal blood flow
131
Target temperature prior to circulatory arrest
15-17 C (the longer the operation, the colder the pt needs to be)
132
How do you use the EEG to monitor hypothermia?
Once the EEG is isoelectric (15-20C nasopharygeal), the pt is cooled for 10 minutes before DHCA is initiated to ensure adequate, homogenous cooling of the brain
133
How long is circulatory arrest safe at a temperature of 36, 32, 28, 24, 20 and 16C?
36: 1 min
32: 5 min
28: 10 min
24: 20 min
20: 30-40 min
16: 45-60 min
134
What is the generally accepted time for circulatory arrest?
<60 minutes
| Anything greater and most suffer from irreversible brain injury
135
Who can tolerate longer periods of circulatory arrest?
Neonates and children
136
Complications of DHCA
1. Any complication of hypothermia (coagulopathy and profuse bleeding)
2. Potential neurologic complications (too long, too rapid cooling, too repaid rewarming)
137
What can happen with rapid cooling (<20 min) in DHCA?
-Lower neurodevelopmental outcome scores
138
What can happen with rapid re-warming in DHCA?
- Promotes systemic gas bubble formation, cerebral oxygen desaturation and uneven warming
- Organ damage
- Deleterious to neurologic outcomes
139
What is the ideal speed of rewarming from DHCA?
<1C core temperature rise per 3 minutes of bypass time. Re-warming should end when nasopharyngeal temperature reaches 35C
140
DHCA management
1. Nasal temperature probe
| 2. Additional brain protection (ice, intermittent cerebral perfusion)
141
What is retrograde cerebral perfusion?
The perfusionist can deliver cold blood to the head from the SVC
142
What is antegrade cerebral perfusion?
R axillary artery perfusion can perfuse the lower extremities with the regular arterial cannula and the head with the extra perfusion line
143
Disadvantage of antegrade cerebral perfusion compared to DHCA
Placement of an extra perfusion line can increase risk of stroke
144
Near infared spectroscopy to measure O2 saturation in cerebral vessels
Cerebral oximeter (rSO2)
145
Normal rSO2 value
60-80%
| The cerebral vascular bed is 75% venous and 25% arterial
146
What indicates that cerebral perfusion has decreased?
A low rSO2 value
147
Applications for cerebral oximetry
1. Heart surgery
| 2. Sitting position/beach chair surgery
148
When should the anesthetist intervene with rSO2 monitoring?
1. An rSO2 value less than 50%
2. A greater than 20% drop from the individual baseline rSO2
3. A difference of >30% from the L to R hemispheres
* <45% absolute or >25% declines results in poor neurologic outcomes
149
Factors that can decrease rSO2 values
1. Decrease in cerebral blood flow (hypotension, dec CO, hyperventilation)
2. Hypoxemia
3. Anemia (due to 75% venous)
4. Mechanical disturbances
150
How can you increase cerebral SpO2?
1. Increase cerebral perfusion pressure (MAP-ICP)
2. Inc cerebral blood flow (inc PaCO2 by dec minute ventilation, NTG?)
3. Inc FiO2
4. Inc CO
5. Inc Hct
6. Dec cerebral metabolism (inc anesthetic or dec temperature)
151
Normal PT (prothrombin time)
12-15 seconds
152
Normal PTT (partial thromboplastin time)
25-40 seconds
153
Normal INR
0.9-1.1
154
How does unfractioned heparin work?
Binds and enhances the activity of antithrombin III 1000 fold
155
Does heparin affect the intrinsic or extrinsic pathway?
Intrinsic
156
What drug reverses heparin?
Protamine
157
Can you administer heparin from a peripheral IV for a bypass?
No, you must administer it through a central line
158
What is the heparin dose for standard CPB, and when is it dosed?
300-400 units/kg dosed just prior to aortic cannulation
159
Used to assess coagulation in the cardiac OR when heparin is given
Activated Clotting Time (ACT)
160
Normal ACT
100-150 seconds
161
Goal ACT required prior to going on pump for cardiac surgery
>450 seconds
162
When a patient's immune system develops antibodies against heparin
Heparin induced thrombocytopenia
163
What does HIT cause?
Thrombocytopenia (low platelet count) and thrombosis
164
HIT occurs with what types of heparin?
Standard heparin and (to a lesser extent) with fractioned heparin
165
What is antithrombin III deficiency?
- Low levels of AT-III, shows resistance to heparin
| - can be inherited or acquired
166
How do you manage antithrombin III deficiency?
1. Replace the AT-III
| 2. Administer FFP
167
Most common example of fractioned (LMW) heparin
Lovenox (enoxaparin)
168
How is Lovenox different from standard heparin?
1. It is dosed subQ
2. Longer lasting (12-24 hrs)
3. Does not affect/prolong PTT as much (used anti-Xa assay)
4. Not reversed as reliably with protamine
169
How does coumadin work?
Vitamin K antagonist that affects the extrinsic pathway
170
How is coumadin dosed?
PO
171
What test does coumadin affect?
PT and INR (extrinsic)
172
What can reverse coumadin effects?
1. FFP
| 2. Vitamin K
173
How long does Plavix (clopidogrel) last?
5-7 days
174
How is plavix dosed?
PO
175
How is plavix reversed?
Platelets over a long period of time
176
When should ASA be discontinued prior to elective operations?
7 days prior
177
What is the recommendation for pts that underwent balloon angioplasty for managing dual antiplatelet therapy?
Dual antiplatelet therapy is required for 14 days
178
Recommendation for dual antiplatelet therapy for bare metal stent nonurgently
DAT required for 1 month
- elective surgery should be delayed for 1 month
- Urgent surgery may continue with ASA but not plavix
179
Recommendation for dual antiplatelet therapy for bare metal stent urgently
DAT required for 1 year
- Elective surgery delayed for 1 year
- Urgent surgery continue wtih ASA and not plavix
180
Recommendation for antiplatelet therapy for drug-eluting stent, non urgently
DAT required for 6 months
- elective surgery should be delayed for 6 months
- urgent surgery may continue with ASA and not plavix
181
Recommendation for antiplatelet therapy for drug-eluting stent, urgently
DAT required for 1 year
- elective surgery should be delayed for 1 year
- urgent surgery may continue with ASA and not plavix
182
How does Xarelto work?
PO direct factor Xa inhibitor, causes anticoagulation by binding factor Xa
183
How is Xarelto (rivaroxiban) reversed?
Andexxa
184
When should Xarelto be discontinued prior to surgery?
24 hours
185
How does Eliquis (apixaban) work?
Direct factor Xa inhibitor
186
How is eliquis reversed?
Andexxa
187
When should eliquis be discontinued prior to elective surgery?
48 hours
188
Thrombolytic drugs
rtPA, Streptokinase, Urokinase
189
When should thrombolytics be discontinued prior to elective surgery?
10 days
190
When is a direct thrombin inhibitor used?
For anticoagulation in cardiac surgery in pts that cannot receive Heparin due to HIT
-Argatroban
191
When is protamine dosed?
After the pt is taken off CPB, given peripherally and slowly over 10 min
192
What is the dose of protamine?
1 mg protamine per 100 units of heparin
193
What is the mechanism of protamine?
Binds to heparin directly
| -Has anticoagulation properties when given by itself
194
Adverse effects of protamine
1. Hypotension
2. Anaphylactoid reactions (with rapid or central administration)
3. Possible catastropic pulmonary vasoconstriction
195
What is prothrombin complex concentrate (PCC)?
- Contains vitamin K dependent clotting factors (II, VII, IX, X)
- Used to treat life threatening hemorrhage in unstable patients
- Can be given as alternative to FFP as part of a massive hemorrhage protocol
- Concentrated extract from FFP
196
Each vial of PCC contains the same amount of factor IX that would be found in ___ units of FFP
2 units
197
Advantages of PCC
1. Twice as fast as FFP
2. Single dose every 24 hours, much less volume required
3. Half the adverse effects of FFP
4. Faster prep time (does not require thawing)
198
Disadvantages of PCC
1. Up to 20x more expensive than FFP
| 2. Shorter acting than FFP
