Title: The role of the perfusionist Conny Rundby
1The role of the perfusionistConny Rundby
- Dep. of Cardiothoracic Surgery Anesthesiology
- Karolinska University Hospital
- Stockholm
2Introduction
- Protocol for weaning - criteria and procedure
- The implementation - gathering and evaluation
- All that other stuff - incidents, troubles
and state of mind
3The 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
4The criteria
5The protocol
6The protocol
7The 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
8The 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
9The 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)
10The protocol - evaluation
11The protocol - evaluation
12The protocol - evaluation
13Important 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
14Troubles 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?
15Troubles Incidents
Exposure state of mind
16Thank you for your attention