P186D

Program Evaluation

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Program Evaluation

Please rate the extent to which this activity met the following objectives:

1 = poor, 2 = fair, 3 = good, 4 = very good, 5 = excellent

Review identification of bi-ventricular failure*

	1	2	3	4	5

1 is Poor, 5 is Excellent

Learn the nuances of different support devices*

	1	2	3	4	5

1 is Poor, 5 is Excellent

Determine when oxygenation is required*

	1	2	3	4	5

1 is Poor, 5 is Excellent

Please rate the faculty on their teaching ability:

1 = poor, 2 = fair, 3 = good, 4 = very good, 5 = excellent

Daniel Burkhoff, MD, PhD*

	1	2	3	4	5

1 is Poor, 5 is Excellent

John M. Lasala, MD, PhD*

	1	2	3	4	5

1 is Poor, 5 is Excellent

Impella 5.0 followed by addition of ECMOECMO aloneImpella CP followed by addition of Impella RPECMO followed by addition of Impella CPIABP followed by addition of ECMO

CVP is typically much lower than PCWPECMO aloneCVP and PCWP can always be normalized through appropriate selectionand adjustment of combined right and left ventricular support devicesPCWP can be normal or only mildly elevated despite marked elevations ofCVPFollowing initiation of left-sided support alone, CVP typically decreases

a. Often requires surgical placementb. Inadequate systemic perfusionc. Fails to unload the Left Ventricled. Is an optimal biventricular support device

You answered incorrectly.

The correct answer is c. “ECMO fails to unload the ventricle” The high systemic flow of the ECMO inhibits Aortic Valve opening and thus reduces Left ventricular emptying while the left ventricle continues to fill from left atrial flow potentially distending the ventricle. The other choices are not correct as VA ECMO is frequently inserted surgically, most often provides adequate systemic perfusion and is not an optimal device for right or biventricular support.

You answered correctly!

The correct answer is c. “ECMO fails to unload the ventricle” The high systemic flow of the ECMO inhibits Aortic Valve opening and thus reduces Left ventricular emptying while the left ventricle continues to fill from left atrial flow potentially distending the ventricle. The other choices are not correct as VA ECMO is frequently inserted surgically, most often provides adequate systemic perfusion and is not an optimal device for right or biventricular support.

a. CVP is typically much lower than the PCWPb. PCWP can be normal or only mildly elevated despite marked elevations of CVPc. Following initiation of isolated left-sided support, CVP typically decreasesd. Elevations of CVP are of mild concern compared to PCWP

You answered incorrectly.

The correct answer is c. “PCWP can be normal or mildly elevated despite marked elevations of CVP” as CVP is a reflection of volume status, RV function and pulmonary vascular resistance. Elevations of CVP can be independent of LV function and PCWP, particularly in the setting of right or biventricular failure. Other options are incorrect because (a) the CVP can be markedly higher than the PCWP in RV failure, (c) CVP may not decrease post isolated LV function depending on the state of RV function and pulmonary vascular resistance. Finally (d) is incorrect
as elevations of CVP carry significant risk for poor outcomes.

You answered correctly!

The correct answer is c. “PCWP can be normal or mildly elevated despite marked elevations of CVP” as CVP is a reflection of volume status, RV function and pulmonary vascular resistance. Elevations of CVP can be independent of LV function and PCWP, particularly in the setting of right or biventricular failure. Other options are incorrect because (a) the CVP can be markedly higher than the PCWP in RV failure, (c) CVP may not decrease post isolated LV function depending on the state of RV function and pulmonary vascular resistance. Finally (d) is incorrect as elevations of CVP carry significant risk for poor outcomes.

a. More frequently present than appreciatedb. Increases mortality riskc. Is common in SCAI class D and E Shockd. All of the above

You answered incorrectly.

The correct answer is (d), “all the above”, reflecting the underrecognized frequency (a) of CVP elevation and mortality risk (b) in patients with cardiogenic shock which is further supported by being observed frequently in SCAI class D and E shock.

You answered correctly!

The correct answer is (d), “all the above”, reflecting the underrecognized frequency (a) of CVP elevation and mortality risk (b) in patients with cardiogenic shock which is further supported by being observed frequently in SCAI class D and E shock.

a. A fall in PCWPb. Failure to demonstrate aortic valve opening by echocardiographyc. An increase in arterial pulse pressured. All of the above

You answered incorrectly.

The correct answer is (b), “failure to demonstrate aortic valve opening by echocardiography” which occurs when the high systemic flow from the AV ECMO circuit impairs opening of the aortic valve which can be seen on echo. However, LV filling continues from the pulmonary circulation via the left atrium, thus distending the LV and increasing left ventricular end diastolic pressure (reflected in a rising PCWP. The consequence is worsening ischemia due to increased LV wall stress. Answer (a) is incorrect based on the rise in LV filling pressures and the loss of LV ejection reduces pulse pressure making option (c) incorrect, and consequently making (d) incorrect as well.

You answered correctly!

The correct answer is (b), “failure to demonstrate aortic valve opening by echocardiography” which occurs when the high systemic flow from the AV ECMO circuit impairs opening of the aortic valve which can be seen on echo. However, LV filling continues from the pulmonary circulation via the left atrium, thus distending the LV and increasing left ventricular end diastolic pressure (reflected in a rising PCWP. The consequence is worsening ischemia due to increased LV wall stress. Answer (a) is incorrect based on the rise in LV filling pressures and the loss of LV ejection reduces pulse pressure making option (c) incorrect, and consequently making (d) incorrect as well.

YesNo

If no, please explain:

More effectiveThe sameLess effective

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