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MGH Short-term Mechanical Support Heart/Lung Symposium 2018

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MGH Short-term Mechanical Support Heart/Lung Symposium 2018
September 28-29, 2018

Massachusetts General Hospital
O'Keeffe Auditorium
55 Fruit Street
Boston, MA 02114

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 call 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.

Learning 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

Target 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.

Agenda

Friday, September 28,2018
8:30 AMIntroduction
Mauricio Villavicencio, MD
8:40Physiology of Advanced Respiratory Failure
Kathryn Hibbert, MD
9:10Physiology of Cardiogenic Shock
Sunu Thomas, MD
9:40Break
10:00Percutaneous Axial Left and Right Heart Support
Farouc Jaffer, MD
10:25Percutaneous Right Heart Support by Cannulation
Mani Daneshmand, MD
10:50ECMO: Selection Criteria | Indication, Contraindications, Risk Stratifying
Gaston Cudemus, MD
11:25Case Presentation
Phillip Spencer, MD
11:55Lunch
12:40 PMCannulation Strategies/ECMO Initiation | Respiratory Failure
Nathalie Roy, MD
1:05Cannulation Strategies/ECMO Initiation | Cardiogenic Shock
Mani Daneshmand, MD
1:40Debate: Advanced Ventilation Management vs. Veno-venous ECMO
Lorenzo Berra, MD and Yuval Raz, MD
2:30Break
2:45Wet Lab Stations:
Peripheral ECMO Cannulation
Central Cmag Cannulation
Impella
Protex Duo
Mauricio Villavicencio, MD
4:15 PMAdjournment of Day One
Saturday, September 29, 2018
8:30 AMECMO Networking | Out of Hospital Transport
Mani Daneshmand, MD
8:55Pharmacokinetics on ECMO
Lauren Devine, Pharm D.
9:20Nursing Care of ECMO | Wounds, Mobilization, In-Hospital Transport, Family Support
Kathleen Schultz, RN
9:50ECMO Complications
Mauricio Villavicencio, MD
10:15Break
10:30Bridge to Bridge
David D'Alessandro, MD
10:55Bridge to Transplant
Mauricio Villavicencio, MD
11:20Bridge to Recovery
Steven Keller, MD
11:45Lunch
12:30 PMEnd of Life
Emily Rubin, MD
12:55Debate | ECMO vs. Impella for Severe Acute Cardiogenic Shock
David Dudzinski, MD and Mani Daneshmand, MD
1:35ECMO in Difficult Settings | ECPR, Trauma, Sepsis, Pregnancy
Nathalie Roy, MD
2:00Video Cannulation for ECMO | Venoarterial, Veno-Venous
Amy Fiedler, MD
2:15Console, Circuit, CVVH Connections
Alex Legassey, RRT
3:40EMO Initiation: Flows, Vent Setting, Gases and Sweep
Kenneth Shelton, MD
4:05Anticoagulation - Sedation Management
Gaston Cudemus, MD
4:30Case Presentation and Discussion
John Trahanas, MD
Mauricio Villavicencio, MD
Kenneth Shelton, MD
Nathalie Roy, MD
4:50Final Remarks
Mauricio Villavicencio, MD
5:10 PMAdjournment of Educational Activity

Faculty

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

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

Lauren Devine, Pharm D.
Clinical Pharmacist
Cardiac ICU
Massachusetts General Hospital

David M. Dudzinski, MD
Director, Cardiac Intensive Care Unit
Massachusetts General Hospital

Amy Fiedler, MD
Cardiothoracic Surgery Resident
Massachusetts General Hospital

Kathryn Hibbert, MD
Instructor in Medical 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

Steven P. Keller, MD, PhD
Instructor in Medicine
Harvard Medical School
Medical Director, ECMO
Brigham and Women's Hospital

Gregory D. Lewis, MD
Associate Professor of Medicine
Harvard Medical School
Medical Director, Heart Failure & Transplant
Director, Cardiopulmonary Exercise Laboratory
Massachusetts General Hospital

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
MGH 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

John Trahanas, MD
Cardiothoracic Surgery Resident
Massachusetts General Hospital

Registration 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 atAOKEEFE@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.

Provided By:

Provided by Massachusetts General Hospital Corrigan Minehan Heart Center & Partners HealthCare System

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CME Information

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 12.75AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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