2015 SCAI/ACC/HFSA/STS Clinical Expert Consensus Statement on the Use of Percutaneous Mechanical Circulatory Support Devices in Cardiovascular Care

Abstract

Although historically the intra-aortic balloon pump has been the only mechanical circulatory support device available to clinicians, a number of new devices have become commercially available and have entered clinical practice. These include axial flow pumps, such as Impella(®); left atrial to femoral artery bypass pumps, specifically the TandemHeart; and new devices for institution of extracorporeal membrane oxygenation. These devices differ significantly in their hemodynamic effects, insertion, monitoring, and clinical applicability. This document reviews the physiologic impact on the circulation of these devices and their use in specific clinical situations. These situations include patients undergoing high-risk percutaneous coronary intervention, those presenting with cardiogenic shock, and acute decompensated heart failure. Specialized uses for right-sided support and in pediatric populations are discussed and the clinical utility of mechanical circulatory support devices is reviewed, as are the American College of Cardiology/American Heart Association clinical practice guidelines.

Adrenomedullin: a marker of impaired hemodynamics, organ dysfunction, and poor prognosis in cardiogenic shock

“…Nevertheless, in patients with activations of systemic inflammatory response, mortality has been reported to remain high related to other causes of death [32]. After initial medical stabilization, in many centers, mechanical assist devices are an increasingly used alternative to support circulation and allow recovery of stunned or hibernating myocardium if clinical signs of recovery are absent [33–35]. It seems that to increase survival, these advanced therapies should be started before irreversible end-organ dysfunction has occurred to carefully selected patients, considering the costs and possible complications of these therapies [36].…”

Implantable Ventricular Assist Device Use and Outcomes in People With End‐Stage Renal Disease

“…However, unlike our analysis, that analysis included both external circulatory support devices ( ICD‐9‐CM 37.62 and 37.65) and implantable VADs 28, 29. Thus, temporary circulatory support devices were included, which have different indications and outcomes than durable VADs, including placement in dire circumstances such as acute cardiogenic shock or cardiopulmonary arrest 30. This may in part explain the higher reported in‐hospital mortality (51.6%) compared with our cohort (40.6%).…”

High-risk percutaneous coronary intervention with Impella CP hemodynamic support. A case series and method presentation

“…According to one definition, high-risk PCI is the treatment of an unstable patient with an ejection fraction of less than 25% or the target vessel supplying more than half of the myocardium [10]. However, the LVEF cut-off value may vary from 25% to 40%, depending on the expert’s opinion [2, 3]. Complex procedures usually require long procedural times and challenging techniques, such as rotational atherectomy, and are more prone to acute vessel occlusion, low-flow or distal embolization and myocardial necrosis.…”

“…Its benefit of improving long-term survival after high-risk PCI was confirmed in a recent meta-analysis [4]. However, IABP only modestly increases cardiac output and coronary blood flow, and may provide insufficient circulatory support when a hemodynamic collapse occurs [2, 3]. The Impella CP axial flow pump (ABIOMED Inc., Danvers MA, USA) is another percutaneous device, which offers more effective hemodynamic support compared to IABP [5, 6].…”