MCS Advances Lead to ICU Management Challenges

STS/AATS CRITICAL CARE SYMPOSIUM

Sunday

8:00 a.m. – 12:00 p.m.

Room 351DEF

The increased use of mechanical circulatory support (MCS) has extended the lives of thousands of cardiac patients, but it has created challenges in the form of lengthy and expensive stays in cardiac intensive care units.

“These patients require a major utilization of resources—both hardware and human-ware. We thought it was time to specifically talk about how to care for them from an intensive care point of view,” said Glenn J.R. Whitman, MD, Chair of the STS Workforce on Critical Care and co-moderator of a symposium that will address overcoming the challenges. “This is not about how to put in a ventricular assist device (VAD). Rather, it will address how to think about MCS patients, so as to prevent or treat postoperative problems.”

The session is divided into three parts: managing patients on MCS, dealing with right ventricular dysfunction, and using a team approach. Each part will end with a discussion and examples of difficult cases.

The latest advances in left ventricular assist devices, interpreting the hemodynamics of patients on these devices, and tailoring the use of extracorporeal membrane oxygenation (ECMO) is the focus of the first section.

Vassyl A. Lonchyna, MD

Vassyl A. Lonchyna, MD

“Our aim is to refine our management of these patients in the intensive care unit because there are more patients with VADs being brought in,” said co-moderator Vassyl A. Lonchyna, MD, adding that the speakers will share their device knowledge. “There are nuances to the approach to these patients that highly experienced surgeons, cardiologists, and intensivists can pass on to the audience.”

Among the topics discussed will be whether drugs or fluids should be used to control hemodynamics and which auxiliary actions should be taken when patients are on ECMO, said Dr. Lonchyna, from The University of Chicago, who is studying medical school curricula in Ukraine as part of the Fulbright Scholar program.

Managing the right ventricle will be covered in three presentations that will focus on the interaction of the lungs with the right ventricle, noninvasive assessment using ultrasound and echocardiograms, and recognizing and treating right ventricle failure, said co-moderator Rakesh C. Arora, MD, PhD.

“These patients are challenging, so trying to understand the physiology and the heart-lung interactions is key,” said Dr. Arora, of the University of Manitoba in Winnipeg, Canada. “It is critical to identify important signs before you get into trouble with the failing right ventricle, and it involves the whole interdisciplinary team.”

Kevin W. Lobdell, MD

Kevin W. Lobdell, MD

That team-based approach will be highlighted in presentations about the roles of the intensivist and the surgeon, as well as using the “liberation bundle” to separate a patient from a ventilator through mobilization, and avoiding and treating delirium—all with the help of the patient’s family, said co-moderator Kevin W. Lobdell, MD.

“It is an inclusive, interactive process with the entire team—nurses, nurse practitioners, physician assistants, intensivists, and surgeons,” said Dr. Lobdell, of Sanger Heart & Vascular Institute in Charlotte, N.C. “It is so complex that no one person has all the pieces to the puzzle.”

Aaron M. Cheng, MD, of the University of Washington Medical Center in Seattle, also is a co-moderator.

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