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Short-term Mechanical Support Heart/Lung Symposium 2018

This course is designed to provide the fundamentals of the management of short-term support through multidisciplinary case scenarios to narrow the professional practice gap.

Description

The specialty of cardiovascular surgery as well as the perioperative care of cardiac surgical patients is undergoing tremendous evolution. Patients presenting for coronary artery bypass grafting, valve repair and replacement, repair of complex aortic procedure, aneurysms, and dissections are older with more complex problems. Heart and lung transplantation techniques continue to improve. In this context, short-term circulatory and respiratory support has gained significant importance. Essentially, short-term support is used for cardiogenic shock and catastrophic respiratory failure from diverse causes in which conventional therapy has failed. This can occur in a wide variety of circumstances.

In the field of transplantation, the scarcity of donors makes the wait-time unpredictable and long. If the patient's clinical condition worsens, short-term support is a life-saving technology for a bridge-to-transplant strategy. Moreover, short-term support may allow the implantation of durable ventricular assist devices when transplant is not possible, the so-called bridge-to-bridge strategy. In addition, severe cardiorespiratory conditions may be treated with conventional therapies, but short-term support may be needed transiently to support life and avoid end-stage organ failure. Antibiotics may need time to improve a life-threatening pneumonia, but short-term support can provide oxygenation and carbon dioxide removal to wait for recovery. A complex cardiac operation may need circulatory support postoperatively to wait for the surgical inflammation to subside. Cardiac surgeons, cardiologists, anesthesiologists, perfusionists, intensive care physicians, and nurses must now develop an understanding of the management of patients with a wide variety of support devices including intra aortic balloon counter pulsation (IABP), Impella, Tandem Heart, extracorporeal membrane oxygenation (ECMO), and C-Mags. Such devices are not managed in a vacuum by a single individual but by a multidisciplinary care team. The current model is that team members often understand such devices only in the context of their particular care area rather than how actions in their area may affect other management. Trainees in one discipline are not provided the vision of management in other specialties.

Our course is designed to provide the fundamentals of the management of short-term support through multidisciplinary case scenarios to narrow the professional practice gap. Simulated cases with medical professionals trained in such devices but acting as actors will present "real life" situations in conjunction with brief didactic presentations and discussion.

Provided By

Massachusetts General Hospital Corrigan Minehan Heart Center & Partners HealthCare System

Accreditation

Partners HealthCare System is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Partners HealthCare System designates this live activity for a maximum of 12.75 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Audience

This activity is intended for cardiac surgeons, cardiologists, intensive care physicians and nurses, anesthesiologists, cardiac anesthesiologists, perfusionists, biomedical technologists, pharmacists, nurse anesthetists, as well as advanced practice nurses. In the past, the course was also attended by medical students in anesthesia and surgery rotation.

Objectives

Upon completion of this activity, participants will be able to:

  1. Describe an ECMO circuit including pumps, filters, tubing, safety monitors, oxygenators, heat variations in the set up
  2. Recognize and explain the different types of cannulae and cannulation strategies for patients
  3. Describe and initiate ECMO
  4. Recognize the indications for ECMO
  5. Manage severe complications associated with the institution of ECMO
  6. Interpret hemodynamic data for patients with short-term support
  7. Determine the need for and discuss alternative management of failure to wean from cardiopulmonary intra-aortic balloon pump, Impella, extracorporeal membrane oxygenation and C-mags.
  8. Demonstrate function as a member of a multidisciplinary team caring for a patient on short-term in a simulated setting

Fees

Physicians: $380.00

Residents/Fellows: $100.00

Other Health Care Professionals: $100.00

Scientists, Industry Professionals, Other: $100.00

Cancellation Policy:

Registrations cancelled on or before September 14, 2018 will be refunded, less a $20 administrative fee. Registrations cancelled after September 14, 2018 will not be refunded. Contact partnerscpd@partners.org if you require assistance in cancelling your online registration.

Contact

For questions regarding this activity, please contact Audrey O'Keefe at AOKEEFE@mgh.harvard.edu.

For questions regarding registration or CME information, please contact Partners Office of Continuing Professional Development at partnerscpd@partners.org or 857-282-2514.

Friday, September 28, 2018

8:30 am - Introduction, Mauricio Villavicencio, MD

8:40 am - Physiology of Advanced Resipiratory Failure, Kathryn Hibbert, MD

9:10 am - Physiology of Cardiogenic Shock, Sunu Thomas, MD

9:40 am - Break

10:00 am - Percutaneous Axial Left and Right Heart Support, Farouc Jaffer, MD

10:25 am - Percutaneous Right Heart Support by Cannulation, Mani Daneshmand, MD

10:50 am - ECMO: Selection Criteria | Indication, Contraindications, Risk Stratisfying, Gaston Cudemus, MD

11:25 am - Case Presentation, Phillip Spencer, MD

11:55 am - Lunch

12:40 pm - Cannulation Strategies/ECMO Initiation | Respiratory Failure, Nathalie Roy, MD

1:05 pm - Cannulation Strategies/ECMO Initiation | Cardiogenic Shock, Mani Daneshmand, MD

1:40 pm - Debate: Advanced Ventilation Management vs. Veno-venous ECMO, Lorenzo Berra, MD and Yuval Raz, MD

2:30 pm - Break

2:45 pm - ECMO Management | Console, Circuit, CVVH Connections, Alex Legassey, BS, RRT

3:10 pm - ECMO Initiation | Flows, Vent Setting, Gases and Sweep, Ken Shelton, MD

3:35 pm - Anticoagulation | Sedation Management, Gaston Cudemus, MD

4:00 pm - Case Presentation, Krish Chaudhuri, MD

Discussion: Mauricio Villavicencio, MD Nathalie Roy, MD Kenneth Shelton, MD

Adjournment of Day One

Saturday, September 29, 2018

8:30 - AM ECMO Networking | Out of Hospital Transport, Mani Daneshmand, MD

8:55 - Pharmacokinetics on ECMO, Alexander Y. Toyoda, Pharm D.

9:20 - Nursing Care of ECMO | Wounds, Mobilization, In-Hospital Transport, Family Support, Kathleen Schultz, RN

9:50 - ECMO Complications, Mauricio Villavicencio, MD

10:15 - Break

10:30 - Bridge to Bridge, David D'Alessandro, MD

10:55 - Bridge to Transplant, Mauricio Villavicencio, MD

11:20 - Bridge to Recovery, Sunu Thomas, MD

11:45 - Lunch

12:30 PM - End of Life, Emily Rubin, MD

12:55 - Debate | ECMO vs. Impella for Severe Acute Cardiogenic Shock, Navine Kapoor, MD and Mani Daneshmand, MD

1:35 - ECMO in Difficult Settings | ECPR, Trauma, Sepsis, Pregnancy, Nathalie Roy, MD

2:00 - Video Cannulation for ECMO | Venoarterial, Veno-Venous, Amy Fiedler, MD

2:15 - Wet Lab Stations: Peripheral ECMO Cannulation Central Cmag Cannulation Impella Protex Duo, Mauricio Villavicencio, MD

3:40 - Final Remarks, Mauricio Villavicencio, MD

4:00 - Adjournment of Educational Activity

Mauricio Villavicencio, MD

Course Director

Surgical Director of Lung Transplantation, Massachusetts General Hospital

Lorenzo Berra, MD

Assistant Professor of Anesthesia, Harvard Medical School

Medical Director, Anesthesia Critical Care and Pain Medicine/Respiratory Care Services, Massachusetts General Hospital

Krishanu Chaudhuri, MD

Clinical Fellow in Cardiac Surgery, Massachusetts General Hospital

Gaston Cudemus, MD

Instructor in Anesthesia, Harvard Medical School

Cardiothoracic Anesthesiology and Critical Care Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital

Mani Daneshmand, MD

Assistant Professor of Surgery, Duke University School of Medicine

David A. D'Alessandro, MD

Associate Professor of Surgery, Harvard Medical School

Surgical Director, Cardiac Transplantation and Ventricular Assist Device, Massachusetts General Hospital

Amy Fiedler, MD

Cardiothoracic Surgery Resident, Massachusetts General Hospital

Kathryn Hibbert, MD

Instructor in Medicine, Harvard Medical School

Director, Medical ICU Division of Pulmonary and Critical Care, Massachusetts General Hospital

Farouc Jaffer, MD

Associate Professor of Medicine, Harvard Medical School, Massachusetts General Hospital

Navin K. Kapur, MD

Director, Acute Mechanical Circulatory Support Program

Associate Professor Tufts University School of Medicine

Alex Legassey, BS, RRT

Respiratory Therapy, Massachusetts General Hospital

Yuval Raz, MD

Division of Pulmonary Medicine Lung and Heart-Lung Transplant Program

Medical Director Respiratory ECMO, Massachusetts General Hospital

Nathalie Roy, MD

Instructor in Surgery, Harvard Medical School

Surgical Director of Cardiovascular Critical Care, Boston Children's Hospital

Emily B. Rubin, MD

Optimum Care Committee Pulmonary and Critical Care Medicine, Massachusetts General Hospital

Kathleen Schultz, RN

Critical Care Nurse, Blake 8 Cardiac SICU, Massachusetts General Hospital

Kenneth Shelton, MD

Instructor in Anesthesia, Harvard Medical School

Director Heart Center Intensive Care Units Anesthesiology Critical Care Medicine, Massachusetts General Hospital

Phillip J. Spencer, MD

Cardiothoracic Surgery Resident, Massachusetts General Hospital

Sunu Thomas, MD

Instructor in Medicine, Harvard Medical School

Cardiology Division, Massachusetts General Hospital

Alexander Y. Toyoda, Pharm D

Department of Pharmacy, Massachusetts General Hospital