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Postoperative Care of ECMO/Mechanical Circulatory Support

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Postoperative Critical Care for Adult Cardiac Surgical Patients

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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.

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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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Authors and Affiliations

  1. Department of Cardiothoracic Surgery, University of Washington, Seattle, WA, USA

    Kevin Koomalsingh M.D.

  2. Department of Surgery, Cedars-Sinai Heart Institute, Los Angeles, CA, USA

    Fardad Esmailian M.D.

  3. Heart Transplantation, Cedars-Sinai Heart Institute, Los Angeles, CA, USA

    Fardad Esmailian M.D.

Authors
  1. Kevin Koomalsingh M.D.
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  2. Fardad Esmailian M.D.
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Correspondence to Kevin Koomalsingh M.D. .

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Editors and Affiliations

  1. Shahid Beheshti Univ Med Sci, Sa'adat Abad, Tehran, Iran

    Ali Dabbagh

  2. Cedars-Sinai Heart Institute, Los Angeles, California, USA

    Fardad Esmailian

  3. Brigham and Women's Hospital, Boston, Massachusetts, USA

    Sary Aranki

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Koomalsingh, K., Esmailian, F. (2018). Postoperative Care of ECMO/Mechanical Circulatory Support. In: Dabbagh, A., Esmailian, F., Aranki, S. (eds) Postoperative Critical Care for Adult Cardiac Surgical Patients. Springer, Cham. https://doi.org/10.1007/978-3-319-75747-6_20

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