Journal of cardiothoracic and vascular anesthesia
-
J. Cardiothorac. Vasc. Anesth. · Jul 2024
Anesthetic Management of Intracardiac Migration of Medical Devices.
The use of endovascular, percutaneous interventions to treat cardiac, arterial, and venous pathologies is becoming increasingly common in medical practice. While endovascular device placement typically carries a low risk, device migration remains a persistent problem with these procedures for which anesthesia providers must have a high index of suspicion. Anesthesia providers should be aware of the wide range of indications for such devices, potential migration locations, and hemodynamic consequences of both the inciting pathology and device migration so they can safely care for patients in these settings. This article aims to discuss a case series of five different device migration events, review the literature surrounding the migration of each device, and propose unique anesthetic considerations as well as a systematic approach by which to approach these complications.
-
J. Cardiothorac. Vasc. Anesth. · Jul 2024
Pro: Hemostasis Management of Patients on Extracorporeal Membrane Oxygenation Is Different Than Cardiopulmonary Bypass.
Cardiopulmonary bypass and extracorporeal membrane oxygenation have many similarities, but there are significant differences in managing hemostasis. Cardiopulmonary bypass includes shorter mechanical circulatory support times, blood stasis, higher flows, and an increased blood-air interface. These factors cause differences in the risk of coagulopathy, management of anticoagulation, monitoring of the hemostatic system, and management of coagulopathy. This article aims to identify these key differences in the hemostatic system between patients on cardiopulmonary bypass and those on extracorporeal membrane oxygenation.