Anesthesia Interface and Mechanical Circulatory Support
This domain tests coordination between surgeon, anesthesiologist and perfusion team, including mechanical support selection. The exam emphasizes indications, contraindications and device-related complications.
Core rules
- Preoperative anesthesia assessment identifies difficult airway, aspiration risk, pulmonary hypertension and anticoagulation issues.
- One-lung ventilation requires lung isolation and vigilance for hypoxia, hypercapnia and double-lumen tube malposition.
- IABP augments diastolic perfusion and reduces afterload; it is contraindicated in severe aortic regurgitation and aortic dissection.
- ECMO supports oxygenation or cardiac output but requires anticoagulation and management of differential hypoxia, bleeding and infection.
Worked example
A patient on VA-ECMO for cardiogenic shock develops worsening upper-body oxygenation with a well-positioned cannula. The reasoning should include differential hypoxia from native lung dysfunction and return-flow competition; assess cannula position, native cardiac ejection and oxygenation, not simply increase sweep gas.
Traps
Do not use IABP for severe aortic regurgitation; do not ignore anticoagulation-related bleeding; do not assume ECMO replaces ventilation; do not overlook tube malposition in sudden hypoxia during one-lung ventilation.