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The role of the perfusionist Conny Rundby

The role of the perfusionist Conny Rundby. Dep. of Cardiothoracic Surgery & Anesthesiology Karolinska University Hospital Stockholm. Introduction. Protocol for weaning - criteria and procedure The implementation - gathering and evaluation

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The role of the perfusionist Conny Rundby

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  1. The role of the perfusionistConny Rundby Dep. of Cardiothoracic Surgery & Anesthesiology Karolinska University Hospital Stockholm

  2. Introduction Protocolfor weaning- criteria and procedure The implementation- gathering and evaluation All that “other stuff”- incidents, troubles and state of mind

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

  4. The criteria

  5. The protocol

  6. The protocol

  7. The protocol Before procedure: 2 PVK administration / blood-samples Blood-samples: electrolytes, krea, Hct, platelets CRP, INR, APTT INR>2 At all attempts: Time, rpm, flow, power, PI Symptoms, Doppler BP, HR, 02-sat EF, LVEDD

  8. The protocol Flow dec. 400 rpm every fifth minute to 8000 rpm From 8000 rpm: Full heparinisation ACT >400 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

  9. 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 (<200)

  10. The protocol - evaluation

  11. The protocol - evaluation

  12. The protocol - evaluation

  13. 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

  14. Troubles & Incidents Bleeding, haematoma and vagal reaction Infection Difficulty to participate / low acceptance for the diagnostic equipment Protaminisation regime – pros and cons What do the values and results really stand for?

  15. Troubles & Incidents Exposure & state of mind

  16. Thank you for your attention

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