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Postoperative Care of ECMO/Mechanical Circulatory Support

  • Kevin Koomalsingh
  • Fardad Esmailian
Chapter

Abstract

The perioperative management of mechanical support patients can be challenging. These patients are plagued by decompensated heart failure resulting in a low output state and, consequently, end organ dysfunction. They are additionaly challenged by immobility and deconditioning and very often require emergent temporary support or elective durable support. This can create for a lengthy, arduous convalescence. A standardized approach to critical care management can help optimize both the short and long term outcomes.

Keywords

Extracorporeal membrane oxygenator Cardiovascular Preload Afterload Contractility Hepatic congestion Mesenteric ischemia Endocrine Hematologic considerations Infectious considerations 

Abbreviations

ACT

Activated clotting time

AKI

Acute kidney injury

AMP

Adenosine monophosphate

ARDS

Acute respiratory distress syndrome

BiVAD

Biventricular assist device

CABG

Coronary artery bypass grafting

CFLVAD

Continuous flow left ventricular assist device

CI

Cardiac index

CNS

Central nervous system

CO

Cardiac output

COPD

Chronic obstructive pulmonary disease

CPAP

Continuous positive airway pressure

CPB

Cardiopulmonary bypass

CPR

Cardiopulmonary resuscitation

CT

Computed tomography

CVP

Central venous pressure

CXR

Chest X-ray

DVT

Deep venous thrombosis

ECLS

Extracorporeal life support

ECMO

Extracorporeal membrane oxygenation

FiO2

Fractional inspired oxygen

GI

Gastrointestinal

GIB

Gastrointestinal bleeding

IABP

Intra-aortic balloon pump

ICP

Intra-cranial pressure

ICU

Intensive care unit

iNO

Inhaled nitric oxide

INR

International normalized ratio

IV

Intravenous

LDH

Lactated dehydrogenase

LV

Left ventricle

LVAD

Left ventricular assist device

MAP

Mean arterial pressure

MCS

Mechanical circulatory support

MR

Mitral regurgitation

NMDA

N-methyl-D-aspartate receptor

NSAID

Nonsteroidal anti-inflammatory drugs

OR

Operating room

PA

Pulmonary artery

PAD

Pulmonary artery diastole

PEEP

Peak end-expiratory pressure

PI

Pulsatility index

PPI

Proton pump inhibitor

PTT

Partial prothrombin time

RA

Right atrium

RASS

Richmond Agitation Sedation Scale

RHF

Right heart failure

RR

Respiratory rate

RV

Right ventricle

RVAD

Right ventricular assist device

SaO2

Oxygen saturation

SIMV

Synchronized intermittent mechanical ventilation

SVO2

Mixed venous saturation

TAH

Total artificial heart

TEE

Trans-esophageal echocardiogram

TRALI

Transfusion-related acute lung injury

TTE

Transthoracic echocardiogram

UGIB

Upper gastrointestinal bleeding

V/Q

Ventilation/perfusion

VA ECMO

Veno-arterial extra corporeal membrane oxygenation

VAD

Ventricular assist device

VT

Ventricular tachycardia

WBC

White blood cell

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© Springer International Publishing AG, part of Springer Nature (outside the USA) 2018

Authors and Affiliations

  1. 1.Department of Cardiothoracic SurgeryUniversity of WashingtonSeattleUSA
  2. 2.Department of SurgeryCedars-Sinai Heart InstituteLos AngelesUSA
  3. 3.Heart TransplantationCedars-Sinai Heart InstituteLos AngelesUSA

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