Mid-Atlantic Mechanical Circulatory Support (MCS) Conference

• Provide an overview of cardiogenic shock and principles of shock management.
• Describe currently available temporary and long-term support devices.
• Describe general concepts of patient selection for mechanical circulatory support.
• Highlight recent landmark studies in cardiogenic shock.
• Discuss future direction of cardiogenic shock field and research topics.

• Comprehensive overview of crucial components in building a shock team.
• Identify key points of management beyond mechanical circulatory support devices.

Please note:  All stations will be rotated at designated times. Learners will be divided into four groups.

Utilization of ECMO Support for Cardiogenic Shock

Group 1 

• Illustrate basic concepts of supporting patients in LV or biventricular failure, with specific focus on veno-arterial extracorporeal membrane oxygenation.

Long-term MCS Support LVAD – Introduction and Emergency Troubleshooting 

Group 2 

• Provide an overview of indications of long-term MCS support for LVAD.
• Describe the approach to troubleshoot LVAD emergencies.

Comprehensive Management of Acute and Chronic Right Ventricular Failure:  MCS Strategies and Support

Group 3

• Provide an overview of identification of right ventricular failure, differentiation of etiologies, and management using mechanical circulatory support.
• Illustrate the basic concepts of RV support devices.

Troubleshooting Intra-aortic Balloon Pump (IABP) and Temporary Percutaneous Left Ventricular Assist Device

Group 4

• Interpret intra-aortic balloon pump waveforms, interpretation of placement signal waveform and motor current waveform of temporary percutaneous left ventricular assist device.
• Illustrate the troubleshooting approach for malfunctioning/mal-positioned support devices commonly used in patients with cardiogenic shock.

Utilization of ECMO Support for Cardiogenic Shock 

Group 2

Long-term MCS Support LVAD – Introduction and Emergency Troubleshooting 

Group 3

Comprehensive Management of Acute and Chronic Right Ventricular Failure:  MCS Strategies and Support

Group 4

Troubleshooting Intra-aortic Balloon Pump (IABP) and Temporary Percutaneous Left Ventricular Assist Device

Group 1

Utilization of ECMO Support for Cardiogenic Shock 

Group 3

Long-term MCS Support LVAD – Introduction and Emergency Troubleshooting 

Group 4

Comprehensive Management of Acute and Chronic Right Ventricular Failure:  MCS Strategies and Support

Group 1

Troubleshooting Intra-aortic Balloon Pump (IABP) and Temporary Percutaneous Left Ventricular Assist Device

Group 2

Utilization of ECMO Support for Cardiogenic Shock 

Group 4

Long-term MCS Support LVAD – Introduction and Emergency Troubleshooting 

Group 1 

Comprehensive Management of Acute and Chronic Right Ventricular Failure:  MCS Strategies and Support

Group 2

Troubleshooting Intra-aortic Balloon Pump (IABP) and Temporary Percutaneous Left Ventricular Assist Device

Group 3

• Describe safety considerations during transport.
• Highlight the utility of standardized checklists to ensure device and patient safety.
• Emphasize the need for clear communication and role assignment among team members during transport.

• Describe clinical manifestation and diagnostic strategies.
• Outline principles of acute management.
• Describe indications and options for reperfusion therapy, including systemic thrombolysis, catheter-directed interventions, and surgical embolectomy in massive PE with RV failure.
• Highlight the role of mechanical circulatory support in refractory cases.

• Define Pulmonary Hypertension (PH) and its relevance in the ICU.
• Describe the hemodynamic definitions and classifications of PH.
• Common and subtle clinical presentations of PH and RV failure in critically ill patients.
• Review diagnostic tools, including echocardiography, right heart catheterization, and hemodynamic monitoring, for evaluating PH and RV function in the ICU.

• Review essential pacemaker settings (mode, rate, output, sensitivity) relevant to post-cardiotomy care.
• Discuss common issues such as loss of capture, oversensing, or undersensing, and outline a systematic troubleshooting approach.
• Identify early and late complications associated with epicardial pacemaker wires, including infection lead dislodgement, and tamponade.
• Describe strategies for monitoring and promptly addressing these complications in the postoperative setting.

• Explain the physiological concept of afterload, specifically in the context of left ventricular (LV) function.
• Discuss the interplay between the native heart and the extracorporeal circuit, emphasizing the parallel circulation and dynamic equilibrium established during VA ECMO support.
• Identify pharmacologic and mechanical approaches to reduce afterload while highlighting the importance of individualized management based on patient-specific factors and device settings.
• Review current evidence regarding the benefits and potential complications of afterload reduction strategies in VA ECMO. 

• Identify several scenarios where TEE provides essential, actionable information not easily obtained otherwise.
• Identify primary benefits of TEE over TTE in specific situations.
• Overview of safety considerations for TEE in the ICU.