Optimising haemodynamics in cardiac critical care
Author(s)
Tindale, Alexander
Type
Thesis
Abstract
Whilst there has been much research into cardiac surgery and percutaneous coronary intervention there has been much less focus on other components of care that are important in optimising the haemodynamics of patients undergoing these interventions.
Successful overall management of a patient’s physiological state in these situations involves: (1) accurate monitoring of patients to recognise early signs that cardiac output is compromised, (2) interpreting this data accurately, so that (3) effective and timeous treatment can be implemented.
This thesis addresses these three domains by studying two interventions for patients in these critical cardiac states. The first is cardiac pacing after cardiac surgery. The second is the early identification and methods of treatment in cardiogenic shock.
I address this overall question by examining eight specific questions:
(1) Are haemodynamics and outcomes better when temporary pacing after cardiac surgery is performed using dual-chamber or atrio-biventricular devices?
(2) What effect does systematic optimisation of temporary pacing have upon arterial blood pressure and cardiac output after cardiac surgery?
(3) Can haemodynamic optimisation of temporary pacing be performed using central venous pressure in addition to arterial blood pressure readings?
(4) Can continuous haemodynamic parameters be more accurately measured by incorporating information from the central venous system into pulse-contour algorithms?
(5) If a patient’s haemodynamic state requires permanent pacemaker implantation after cardiac surgery, can one define an optimum time to wait before device implantation?
(6) Is it possible to create a fast and accurate scoring system to identify patients at high risk of haemodynamic compromise on admission with acute coronary syndromes?
(7) Having identified patients at high risk of haemodynamic compromise when presenting with acute coronary syndromes and multivessel disease, which patients should undergo complete revascularisation?
(8) In patients requiring further haemodynamic support with microaxial flow devices, is it possible to create an easily-implemented prognostication system?
Successful overall management of a patient’s physiological state in these situations involves: (1) accurate monitoring of patients to recognise early signs that cardiac output is compromised, (2) interpreting this data accurately, so that (3) effective and timeous treatment can be implemented.
This thesis addresses these three domains by studying two interventions for patients in these critical cardiac states. The first is cardiac pacing after cardiac surgery. The second is the early identification and methods of treatment in cardiogenic shock.
I address this overall question by examining eight specific questions:
(1) Are haemodynamics and outcomes better when temporary pacing after cardiac surgery is performed using dual-chamber or atrio-biventricular devices?
(2) What effect does systematic optimisation of temporary pacing have upon arterial blood pressure and cardiac output after cardiac surgery?
(3) Can haemodynamic optimisation of temporary pacing be performed using central venous pressure in addition to arterial blood pressure readings?
(4) Can continuous haemodynamic parameters be more accurately measured by incorporating information from the central venous system into pulse-contour algorithms?
(5) If a patient’s haemodynamic state requires permanent pacemaker implantation after cardiac surgery, can one define an optimum time to wait before device implantation?
(6) Is it possible to create a fast and accurate scoring system to identify patients at high risk of haemodynamic compromise on admission with acute coronary syndromes?
(7) Having identified patients at high risk of haemodynamic compromise when presenting with acute coronary syndromes and multivessel disease, which patients should undergo complete revascularisation?
(8) In patients requiring further haemodynamic support with microaxial flow devices, is it possible to create an easily-implemented prognostication system?
Version
Open Access
Date Issued
2024-10-24
Date Awarded
01/11/2025
License URL
Advisor
Francis, Darrel
Howard, James
Linton, Nicholas
Publisher Department
National Heart & Lung Institute
Department of Medicine
Publisher Institution
Imperial College London
Qualification Level
Doctoral
Qualification Name
Doctor of Philosophy (PhD)