NPs / PAs

CRNP Dobrushin

Excerpts from our Interview

ImaCor: What does hTEE provide that surrogate heart monitors don’t?

CRNP Dobrushin: We have a lot of mechanical circulatory support device patients post-implantation, as well as regular open heart, vascular, surgical and thoracic patients.

So we have a lot of hemodynamic requirements. We obviously utilize invasive hemodynamic monitoring like pulmonary artery catheters, central venous catheters, and we collect those data and numbers.

But those methods don’t let us look directly at the filling state or look directly at the left and right ventricular functions.

With the ImaCor probe, the mid-esophageal four chamber view helps us assess ventricular assist device speed requirements and see any shift from midline or bowing of the interventricular septum. It also shows us RV and LV chamber size and function and lets us evaluate for any mitral regurgitation.

We interpret all this data to help us guide ideal VAD speed setting, volume requirements, and need for medication support for either ventricle. In sum, the ImaCor method gives information in real-time and then allows us to reassess our interventions after we have done them.

ImaCor: Thank you. How has hTEE impacted your patient population?

CRNP Dobrushin: I think there’s a couple of different things.

In those cardiac surgical patients most often, it’s a patient with a new ventricular assist device who is having issues with low VAD flows.

We don’t know if they’re hypovolemic, we don’t know if they have a tamponade, or if they have new right heart failure, so we can’t really definitively say any of those things from the cardiac monitoring.

We can look at the pulmonary artery catheter numbers, we can look at the VAD numbers, but we can’t say until we actually look at the mechanics of the heart and whether there’s any kind of collections to determine if there’s any dysfunction since the VAD was placed.

That’s what the hTEE allows us to do, promptly and frequently.

ImaCor: When do you typically reach for a transesophageal echo probe?

ImaCor: We use the ImaCor hTEE probe when:

• we see low VAD flows and we’re not sure why;
• we have unexplained hypotension or dysrhythmias and we’re wondering if the VAD is over pumping and sucking down the ventricle;
• we’re concerned about effusion or tamponade;
• we want to know whether we need to give more volume or more inotropic support; and,
• we want to evaluate for SVC collapsibility and guide fluid resuscitation requirements in sepsis/shock patients.