Mechanical Cardiac Circulatory Support: an Overview of the Challenges for the Anesthetist

Notarianni, Andrew; Tickoo, Mayanka; Bardia, Amit

doi:10.1007/s40140-021-00486-x

Cited by 4 publications

(23 citation statements)

References 42 publications

(32 reference statements)

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“…Cranial migration can disrupt blood flow to the left subclavian artery and the left common carotid artery. Confirmation of positioning with radiography, fluoroscopy, and/or TEE is ideally performed on reaching the OR after transport 3. Anesthesiology providers should be aware of signs of IABP-induced ischemia and have a high index of suspicion after transport.…”

Section: Intra-aortic Balloon Pumpmentioning

confidence: 99%

“…An ECMO circuit typically consists of a venous drainage (inflow) cannula, a mechanical pump, a membrane lung with heat exchanger that participates in gas exchange, and a return cannula (outflow) in either a vein (VV) or artery (VA). 3 For VV ECMO, both the inflow and outflow cannulae are on the venous side of circulation. Thus, all extracorporeal blood flow and gas exchange are pre-pulmonary and a VV ECMO circuit provides oxygenation/ carbon dioxide removal yet providing no hemodynamic support.…”

Section: Circuit Designmentioning

confidence: 99%

“…Peripheral VA ECMO is more likely to be seen in noncardiac operating rooms. 3 Many configurations exist, but commonly the drainage cannula is through the femoral vein and the return cannula is through the femoral artery. Blood flow from the return cannula perfuses the patient in a retrograde manner, and a mixture of blood from the ECMO machine with the patient's native circulation is present.…”

Section: Circuit Designmentioning

confidence: 99%

“…Pump flow is a surrogate for CO and is estimated based on the power consumption and pump speed. 44 Overreliance on LVAD flow displayed on the console should be avoided as it is a calculated number and may not reflect the actual CO. 3…”

Section: Intraoperative Monitoringmentioning

confidence: 99%

“…12 The decision to pause anticoagulation perioperatively should be multidisciplinary, with all specialties involved. 3 Patients heparinized in the perioperative setting will have a higher risk of bleeding, yet this does not seem to decrease the incidence of limb ischemia. 13 With the exception of very brief pauses, the balloon should never be turned off and left in the aorta due to the unacceptably high risk of thrombosis.…”

Section: Anticoagulationmentioning

confidence: 99%

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Mechanical circulatory support devices in noncardiac surgery

Trela¹

2022

International Anesthesiology Clinics

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Mechanical circulatory support (MCS) devices are percutaneously or surgically implantable devices that support either the circulatory system, the pulmonary system, or both. Device technology has improved over time, resulting in more patients using MCS, particularly left ventricular assist devices (LVAD). 1 In addition, the COVID-19 pandemic has brought MCS to the forefront due to the utilization of extracorporeal membrane oxygenation (ECMO) to support patients in profound respiratory failure. 2 The increase in MCS patients has led to more patients requiring anesthesia for noncardiac surgery (NCS), which can be secondary to the pathology that required MCS in the first place, a complication of MCS, or an entirely separate pathology. 3 Thus, it is prudent for anesthesiologists to understand the basic principles of how these devices work to provide safe anesthetics. This article focuses on the general principles surrounding the preoperative evaluation of the MCS patient presenting for NCS, focusing on the most likely encountered devices in this scenario: the intra-aortic balloon pump (IABP), ECMO, and the LVAD.

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Section: Intra-aortic Balloon Pumpmentioning

confidence: 99%

Section: Circuit Designmentioning

confidence: 99%

Section: Circuit Designmentioning

confidence: 99%

Section: Intraoperative Monitoringmentioning

confidence: 99%

Section: Anticoagulationmentioning

confidence: 99%

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Mechanical circulatory support devices in noncardiac surgery

Trela¹

2022

International Anesthesiology Clinics

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Risk factors for perioperative intra-aortic balloon pumping application in patients undergoing coronary artery bypass grafting：a single-center experience

Zhao

Chen

et al. 2023

Preprint

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Background: There were few studies on risk factors predicting perioperative application of intra-aortic balloon pumping (IABP) in coronary artery bypass grafting (CABG) patients. The aim of the study is to explore risk factors for perioperative application of IABP in CABG patients. Methods: Patients with preoperative IABP implantation were excluded. 1337 patients undergoing CABG were finally included. Patients were divided into two groups: IABP group and non-IABP group. Medical history, biochemical and ultrasonagraphic parameters were compared between the groups. Multivariate logistic analyse was used to explore possible risk factors. Combined ROC analysis was performed and area under ROC (AUC) was used to decide diagnostic capability of the risk factors. Results: Patients in IABP group had a higher proportion of myocardial infarction (MI) history and atrial fibrillation(AF) history. IABP group also had a larger amount of blood loss and a higher serum level of small, dense low-density lipoprotein (sd-LDL). As for imaging results, IABP group had a lower Left ventricular ejection fraction (LVEF). Multivariate logistic analyse showed that LVEF< 50% (OR, 3.120) , history of MI (OR, 2.006), sd-LDL serum level (OR, 2.201) and blood loss during surgery>1000ml (OR, 2.545) were independent risk factors. Combined ROC analysis showed an AUC of 0.707. Conclusion: For CABG patients, LVEF<50%, history of MI, blood loss during surgery>1000ml and sd-LDL serum level were risk factors for perioperative application of IABP. Combined ROC analysis showed an AUC of 0.707.

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Exploring Perfusion Safety: A Review of Clinical and Non-Clinical Factors with Emphasis on Quality Improvement

Butt

2023

J Cardiol Cardiovasc Res.

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This literature review examines perfusion safety in cardiothoracic surgery, with a primary focus on cardiopulmonary bypass (CPB) and circulatory devices. PRISMA guidelines were followed and various databases, including PubMed, MEDLINE, and Google Scholar, were searched using relevant keywords to identify pertinent studies and literature on the subject. The review traces the historical development of perfusion techniques and underscores the importance of equipment factors, personnel considerations, and perfusion management strategies in ensuring patient safety during CPB and circulatory device usage. Clinical aspects of perfusion safety, encompassing equipment safety features, temperature management, anticoagulation, and blood conservation, are discussed. Non-clinical aspects, including the implementation of standardized protocols, robust training structures, positive team dynamics, and the fostering of a safety-oriented culture, are also examined. Quality improvement initiatives for blood conservation, monitoring, and incident reporting are explored, along with an acknowledgment of the significant contributions of major perfusion societies and boards (AmSECT, SCPS, EBCP) in establishing standards and promoting excellence in the field. Challenges related to device design, patient selection, and perioperative management are addressed, highlighting the need for standardized practices and ongoing research to enhance perfusion safety. This comprehensive review underscores the enduring commitment to advancing perfusion safety and quality through systematic research, education, and collaborative efforts in cardiothoracic surgery.

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Mechanical Cardiac Circulatory Support: an Overview of the Challenges for the Anesthetist

Cited by 4 publications

References 42 publications

Mechanical circulatory support devices in noncardiac surgery

Mechanical circulatory support devices in noncardiac surgery

Risk factors for perioperative intra-aortic balloon pumping application in patients undergoing coronary artery bypass grafting：a single-center experience

Exploring Perfusion Safety: A Review of Clinical and Non-Clinical Factors with Emphasis on Quality Improvement

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