Cardiac Assist Devices

Types

Intra-Aortic Balloon Pump (IABP) (see Intra-Aortic Balloon Pump, [[Intra-Aortic Balloon Pump]])

  • Epidemiology: most commonly used mechanical circulatory support device
  • Indications

Percutaneous Circulatory Assist Devices

Indications

  • Cardiac Allograft Failure/Post-Cardiac Transplant Right Ventricular Failure
  • Cardiogenic Shock Complicating Acute Myocardial Infarction (see xxxx, [[xxxx]]): with or without ischemic mitral regurgitation or ventricular septal rupture
  • Congestive Heart Failure (CHF) (see xxxx, [[xxxx]])
  • High-Risk Coronary Intervention with Complex Coronary Artery Disease and Severe Left Ventricular Dysfunction (EF <35%)
  • Support During High-Risk Percutaneous Valve Procedures
  • Support During Electrophysiologic Procedures in Patients with Severe Left Ventricular Dysfunction: these patients may not tolerate sustained ventricular arrhythmias during the procedure
  • Medically-Refractory (Predominantly Ventricular) Ischemic Arrhythmias

Contraindications

  • xxxx

Devices

  • Impella (see Impella, [[Impella]])
    • Physiology: percutaneous left ventricle to aorta assist device
  • Tandem Heart (see Tandem Heart, [[Tandem Heart]])
    • Physiology: percutaneous left atrial to aorta assist device

Complications

  • xxxx

Extracorporeal Membrane Oxygenation (ECMO) (see Extracorporeal Membrane Oxygenation, [[Extracorporeal Membrane Oxygenation]])

  • Venovenous Extracorporeal Membrane Oxygenation (VV-ECMO)
    • Physiology: provides only respiratory support
    • Indications
  • Venoarterial Extracorporeal Membrane Oxygenation (VA-ECMO): also known as percutaneous cardiopulmonary support (CPS)
    • Physiology: provides both respiratory and hemodynamic support
    • Indications

Ventricular Assist Device (VAD) (see Ventricular Assist Device, [[Ventricular Assist Device]])

Cardiopulmonary Bypass (CPB) (see Cardiopulmonary Bypass, [[Cardiopulmonary Bypass]])

  • Indications
    • Cardiothoracic Surgery

References

  • Extracorporeal membrane oxygenation in severe acute respiratory failure. A randomized prospective study. JAMA. 1979 Nov 16;242(20):2193-6 [MEDLINE]
  • Randomized clinical trial of pressure-controlled inverse ratio ventilation and extracorporeal CO2 removal for adult respiratory distress syndrome. Am J Respir Crit Care Med. 1994 Feb;149(2 Pt 1):295-305 [MEDLINE]
  • Venoarterial extracorporeal membrane oxygenation for treatment of cardiogenic shock: clinical experiences in 45 adult patients. J Thorac Cardiovasc Surg. 2008;135(2):382–388 [MEDLINE]
  • Outcomes and long-term quality-of-life of patients supported by extracorporeal membrane oxygenation for refractory cardiogenic shock. Crit Care Med. 2008;36:1404–1411 [MEDLINE]
  • Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet. 2009 Oct 17;374(9698):1351-63 [MEDLINE]
  • Extracorporeal Membrane Oxygenation for 2009 Influenza A (H1N1) Acute Respiratory Distress Syndrome. JAMA. 2009 Nov 4;302(17):1888-95 [MEDLINE]
  • Extracorporeal Life Support Organization. Patient specific guidelines: a supplement to the ELSO general guidelines. April 2009:15-19 (http://www.elso.med.umich .edu/WordForms/ELSO%20P+%20Specif ic %20Guidelines.pdf)
  • Early and intermediate results of rescue extracorporeal membrane oxygenation in adult cardiogenic shock. Ann Thorac Surg. 2009;88(6):1897–1903 [MEDLINE]
  • Extracorporeal membrane oxygenation for ARDS in adults.  N Engl J Med.  2011;365:1905–1914 [MEDLINE]
  • Extracorporeal membrane oxygenation for respiratory failure in adults.  Curr Opin Crit Care Med.  2012;18:99–104 [MEDLINE]
  • A prospective, randomized clinical trial of hemodynamic support with Impella 2.5 versus intra-aortic balloon pump in patients undergoing high-risk percutaneous coronary intervention: the PROTECT II study. Circulation. 2012;126(14):1717 [MEDLINE]
  • Venoarterial extracorporeal membrane oxygenation support for refractory cardiovascular dysfunction during severe bacterial septic shock. Crit Care Med. 2013 Jul;41(7):1616-26. doi: 10.1097/CCM.0b013e31828a2370 [MEDLINE]
  • Extracorporeal life support devices and strategies for management of acute cardiorespiratory failure in adult patients: a comprehensive review. Crit Care. 2014;18(3):219–229 [MEDLINE]
  • Extracorporeal membrane oxygenation in adults with cardiogenic shock. Circulation. 2015;131(7): 676–680 [MEDLINE]