Berlin Heart EXCOR Pediatric VAD, Manual, Page: 168 / 250

Chapter 13 Weaning and Explantation for BTR and BTT
10 ml / 15 ml pump Weaning Sequence
Day 5
After confirmation of eligibility criteria, the following steps should be
performed in the cath lab under echo guidance
1
:
1. Obtain standard access for RHC (if possible with out sedation).
2. Administer UFH 75 units/kg x _____ kg = _____ mg IV x 1 [max 5000
units].
3. After 5 minutes, reduce the pump rate step-wise from WR (50 bpm)
to 30 bpm in increments of 5 bpm q5 min. After 5 minutes at 30 bpm,
reassess LV size and function.
4. After a total time of 10 min at 30 bpm, stop the pump for 3 min and
reassess LV size and function. During pump stoppage, use the
manual pump to pump twice q30 seconds to minimize the risk of
thrombus formation due to blood stagnation while Ikus is
disconnected.
5. After 3 minutes, initiate norepinephrine infusion at 0.01 mcg/kg/min IV
gtt titrated to MAP 20% above baseline x 5 min. While doing so,
proceed pumping manually twice q30 seconds.
6. If LV size and function acceptable, proceed pumping manually twice
q30 seconds for 3 min . While doing so, reassess LV size & function,
and record RAP, PAP, PCWP and MVS.
7. After 6-minute pump stop: If the patient meets all eligibility criteria,
reconnect pump to Ikus and resume pumping at 50 bpm until the
actual surgical procedure of explantation takes place. If the patient
does not meet all criteria, reconnect Ikus and resume pumping at IR.
Did the patient satisfy all 5 eligibility criteria
throughout the period of weaning and pump
stoppage?
ÿ
NO -STOP
ÿ
YES ­
Proceed
MD________
Tab. 13-3 10 ml / 15 ml pump weaning sequence
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TEE unless echo windows insufficient. The last weaning increment may be less
than 5 bpm if the wean interval is not a multiple of 5.
13.1.6 25 / 30 ml pump
The individual weaning progress is based upon the following parameters:
Parameter Explanation Abbr. Value
initial rate rate prior to any
weaning IR Please enter:
weaning rate lowest rate achieved
during weaning
process, depends
on pump size WR 40 bpm
Tab. 13-4 Important parameters for weaning progress
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