CVP ECMO and Mechanical Circulatory Support Flashcards

What type of mechanical circulatory support device is the Intra-Aortic Balloon Pump (IABP)?

Answer: A counterpulsation device that inflates in diastole and deflates in systole to augment coronary perfusion and reduce afterload

The IABP inflates during diastole to augment diastolic coronary perfusion pressure and rapidly deflates before systole to reduce left ventricular afterload.

During IABP therapy, balloon inflation should ideally be triggered by which cardiac event on the ECG?

Answer: Dicrotic notch on arterial waveform corresponding to aortic valve closure

IABP inflation is timed to the dicrotic notch of the arterial pressure waveform, which represents aortic valve closure and the onset of diastole.

What is a ventricular assist device (VAD)?

Answer: A mechanical pump that augments ventricular output by unloading the ventricle and maintaining systemic flow

A VAD reduces ventricular wall stress by diverting blood from the ventricle through a pump to the aorta, supporting circulation while potentially allowing myocardial recovery.

Which durable mechanical circulatory support device is most commonly implanted as a bridge to heart transplantation in the US?

Answer: Left ventricular assist device (LVAD)

Durable LVADs (e.g., HeartMate 3) are the standard bridge-to-transplant strategy for patients with end-stage heart failure awaiting transplantation.

The Impella device provides hemodynamic support through what mechanism?

Answer: Actively pumping blood from the left ventricle across the aortic valve into the ascending aorta

The Impella is a microaxial pump placed across the aortic valve; its inlet sits in the LV and its outlet in the ascending aorta, actively unloading the LV and increasing cardiac output.

What is the primary goal of the perfusionist when managing a patient on mechanical circulatory support (MCS) outside the OR?

Answer: To maintain adequate end-organ perfusion while minimizing device-related complications as a bridge to recovery or definitive therapy

MCS management targets adequate systemic perfusion (MAP, urine output, lactate) while monitoring for complications (bleeding, thrombosis, hemolysis) until recovery or transplant.