The role of the perfusionist Conny Rundby

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The role of the perfusionistConny Rundby

• Dep. of Cardiothoracic Surgery Anesthesiology
• Karolinska University Hospital
• Stockholm

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Introduction

• Protocol for weaning - criteria and procedure
• The implementation - gathering and evaluation
• All that other stuff - incidents, troubles
  and state of mind

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The criteria

• HARPS -The Harefield Recovery Protocol Study-
• On minimal LVAD flow
• LVEDD lt 6 cm Left Ventricular End Diastolic
  Diameter
• LVESD lt 5 cm Left ventricular end-systolic
  diameter
• LVEF gt 45 Left ventricle ejection fraction
• PCWP lt 12 mmHg Pulmonary capillary wedge
  pressure
• Cardiac Index gt 2.8 L/min/m2
• Peak VO2 gt 16 ml/kg/min
• VE/VCO2 lt 34 (VE) The ratio between total
  ventilation and production of CO2. The
  VE/VO2 is an index of ventilatory efficiency

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The criteria
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The protocol
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The protocol
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The protocol
Before procedure 2 PVK administration /
blood-samples
Blood-samples electrolytes, krea, Hct,
platelets CRP, INR, APTT INRgt2 At all
attempts Time, rpm, flow, power, PI Symptoms,
Doppler BP, HR, 02-sat EF, LVEDD
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The protocol
Flow dec. 400 rpm every fifth minute to 8000
rpm From 8000 rpm Full heparinisation ACT
gt400 Flow dec. 400 rpm every third min to 6000
rpm At every rpm level registration of
parameters and symptoms Rigorous echo exam.
flow-direction, septum, RV, LV, EF, LVEDD, Ml,
Aortic valve
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The protocol
At 6000 rpm Parameter check every second
minute. After 10 minutes Rigorous echo exam
Exercise test bicycle / treadmill Echo exam
Inc. 400 rpm every other minute to 9000
rpm Normalisation of ACT (lt200)
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The protocol - evaluation
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The protocol - evaluation
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The protocol - evaluation
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Important points

• EF 65-80
• LVEDD 37-40
• Slightly reduced global RV function
• Lower peak SBP at 6000 than at 9000 rpm
• De-conditioned. Improvement due to training
• Peak V02 improving
• A low V02 can be derived from de-conditioning and
  high VE/VC02 from anxiety

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Troubles Incidents
Bleeding, haematoma and vagal reaction Infection D
ifficulty to participate / low acceptance for the
diagnostic equipment
Protaminisation regime pros and cons
What do the values and results really stand for?
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Troubles Incidents
Exposure state of mind
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Thank you for your attention