Intra-aortic balloon pumps, ECMO, and ventricular assist devices, including indications and basic management principles.
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- What is the primary mechanism by which an intra-aortic balloon pump (IABP) augments the circulation?
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Counterpulsation: the balloon inflates during diastole to boost coronary perfusion and deflates just before systole to reduce afterload- Where is the tip of a correctly positioned intra-aortic balloon typically located?
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In the descending thoracic aorta, just distal to the origin of the left subclavian artery- What gas is used to inflate an intra-aortic balloon?
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Helium, because of its low viscosity and rapid diffusion characteristics- What ECG or pressure waveform feature is commonly used to time IABP inflation?
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The dicrotic notch on the arterial pressure waveform, corresponding to aortic valve closure- What hemodynamic effect does correctly timed IABP deflation have just before systole?
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It reduces left ventricular afterload, lowering myocardial oxygen demand and improving forward stroke volume- Name a major contraindication to intra-aortic balloon pump use.
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Significant aortic insufficiency (or severe aortic disease such as dissection or significant aneurysm)- What does the acronym ECMO stand for?
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Extracorporeal membrane oxygenation- What are the two main configurations of ECMO based on cannulation?
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Venovenous (VV) ECMO and venoarterial (VA) ECMO- What is the primary purpose of venovenous (VV) ECMO?
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Providing respiratory support (gas exchange) in patients with severe respiratory failure but adequate cardiac function- What is the primary purpose of venoarterial (VA) ECMO?
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Providing both cardiac and respiratory support in patients with combined cardiac and respiratory failure or cardiogenic shock- Why does VV ECMO not provide direct hemodynamic (cardiac output) support?
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Blood is returned to the venous system rather than the arterial system, so it does not bypass or directly assist the failing heart- What complication is specific to peripheral VA ECMO where the native heart still ejects some blood against retrograde arterial flow?
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Differential hypoxia (Harlequin syndrome), where poorly oxygenated blood from the native heart preferentially perfuses the upper body- What is often placed distal to a femoral arterial ECMO cannula to prevent limb ischemia?
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A distal limb reperfusion cannula (distal perfusion catheter)- What is the general purpose of a ventricular assist device (VAD)?
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Mechanically augmenting or replacing the pumping function of a failing ventricle to maintain adequate systemic or pulmonic circulation- What are the three general clinical intent categories for VAD implantation?
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