Interventional Cardiovascular Anesthesiology

[TIVA23]

LOL just kidding (kind of), I wanted to grab your attention!

No but really, why haven't we adapted in the field of Anesthesiology to do interventional procedures? This might sound crazy and I'm sure this is just wishful thinking on my behalf but why aren't we able to do Intra-aortic ballon pumps or VV ECMO canulation.

I know the answer most people are going to give is " well, cardiology/CT surgery does this" but in my opinion, Anesthesiologist would be highly capable of placing intravascular devices under ultrasound guidance with the appropriate training. In fact, I would go as far as to say that we would be far better at this in an emergency situation. Is this not be a possibility? It seems that it would be a tremendous asset to have in a CVICU.

Any feedback? Is this just too wishful of thinking?

P.S if you don't have anything positive to say about this or me, please go ahead and say it, this is not a safe space. Constructive comments/ideas are encouraged.

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[partydoc]

Some places the icu guys do vv ecmo

 

[Robotic Wis-Hipple]

I have a few thoughts;

First, there are places where ICU docs of various backgrounds initiate ECMO, so in the right setting you could be trained and credentialed for it.

But, you know what comes with that? ECMO call......

I'll add that I think it's reasonable to get some exposure/experience in placing these large cannulas (20-31Fr) in the CT realm. I've placed a handful of 20-23Fr IJ cpb cannulas for minimally invasive procedures so I don't think placing an Avalon would be that much bigger of a deal (the 31Fr though is no joke). Recommendations are for fluoro or TTE/TEE verification of wire (neither of which our CTICU does). So from our standpoint it doesn't even require significant TEE skills to acquire a bicaval for wire visualization.

 

[Nivens]

I know it isn't exactly what you were referring to, but on a related note, the cardiac atyendings at my program believe the future of CT anesthesia is in guiding minimally invasive structural interventions with TEE (mitral clip, watchman, etc). Their feeling is we are better positioned to accomplish this than cardiology-trained imagers due to our experience guiding interventions in the OR, which they feel is a different skill-set from diagnosing valvular pathology and assessing function. I can see their point, but also can see some weaknesses in their arguement.

Curious what yall think.

 

[AdmiralChz]

There are some places where anesthesiology runs an ECMO program (Michigan?), they have some interesting perspectives and discussed it at this past SCA. The SCA brochure indicates this will be again discussed this year.

I came away thinking about how labor intensive it would be, but certainly possible.

Anesthesiology places Avalon catheters at my institution under TEE guidance - they are very cool but they are very temperamental and can easily be malpositioned with excessive head movement (especially in an awake patient).

 

[dmk5n]

Why not a varicose vein clinic? Better cash flow.

 

[TIVA23]

Thanks for your responses.

Im glad to hear that we are dabbling in endovascular procedures. It seems that this should be incorporated into a cardiovascular fellowship as ECMO programs continue to expand nationwide and someone is going to have to run the show. I think this is the bull we need to grab by the horns (I don't see CRNA'S doing interventional procedures any time soon)

Anyone know if there has been a push for this being incorporated into a fellowship?

 

[sevoflurane]

Tavr, mitral clip, watchman, baloon valvuloplasties, PVL closures, ASD closures, ECMO.
Hopefully structural heart disease with TEE emphasis is part of most major programs.

We started our ECMO program last year and it ties into our echo service.