MCS

Question 1

Correct position for IABP

Answer 1

Tip should be 2cm distal to the L SCA ostium

Question 2

IABP indications and contraindications

Answer 2

Indications:
- Acute cardiogenic shock
- Prior to high-risk CABG/PCI
- Inability to separate from CPB
- Unstable angina

Contraindications:
- AR
- Aortic aneurysm or dissection
- Severe sepsis
- Severe atherosclerosis
- Severe coagulopathy
- Severe PAD

Question 3

What gas is used to inflate the IABP?

Answer 3

Helium

Question 4

Functions of the IABP

Answer 4

“Counter-pulsatoin”

• Increase myocardial oxygen supply during diastole
• Decrease afterload during systole
• Decreased LVEDP and wall tension

Question 5

Which VV-ECMO configuration is most likely to have recirculation?

Answer 5

Fem-RIJ configuration

• Look for brighter blood in drainage cannula (femoral cannula)
• Paradoxical decrease in systemic oxygenation with increased ECMO flows

Question 6

What are the options for managing North-South syndrome?

Answer 6

• Decrease inotropes
• Optimize ventilation
• Increase ECMO flows
• VAV ECMO

Question 7

Positive predictive values for weaning from VA-ECMO

Answer 7

At minimal ECMO flows (1-1.5L/min):

• LVOT VTI >10
• LVEF >20-35%
• lateral mitral annulus TDI >6cm/s

Question 8

What type of drugs have the highest sequestration in the ECMO circuit?

Answer 8

Highly lipid soluble drugs

Question 9

Goal aPTT and HAL on VA-ECMO

Answer 9

aPTT: 60-80
HAL: 0.3-0.7