Temporary Mechanical Circulatory Support: A Review of the Options, Indications, and Outcomes

Abstract

Cardiogenic shock remains a challenging disease entity and is associated with significant morbidity and mortality. Temporary mechanical circulatory support (MCS) can be implemented in an acute setting to stabilize acutely ill patients with cardiomyopathy in a variety of clinical situations. Currently, several options exist for temporary MCS. We review the indications, contraindications, clinical applications, and evidences for a variety of temporary circulatory support options, including the intra-aortic balloon pump (IABP), extracorporeal membrane oxygenation (ECMO), CentriMag blood pump, and percutaneous ventricular assist devices (pVADs), specifically the TandemHeart and Impella.

Outcomes of patients with cardiogenic shock treated with TandemHeart® percutaneous ventricular assist device: Importance of support indication and definitive therapies as determinants of prognosis

“…Percutaneous MCS devices are becoming increasingly popular for use in cardiogenic shock refractory to pharmacological treatment. The goal of MCS is to improve organ perfusion and oxygen delivery through augmentation of cardiac output while simultaneously supporting cardiac recovery through preload and afterload reduction . Intra‐aortic balloon pumps (IABPs) have traditionally been used to support patients in refractory cardiogenic shock, but these devices have limited ability to augment cardiac output; further, the largest, randomized study found no improvement in survival with IABP use in cardiogenic shock secondary to myocardial infarction .…”

Out-of-Hospital Cardiac Arrest and Acute Coronary Syndromes: Reviewing Post-Resuscitation Care Strategies

“…5 Peripherally inserted temporary ventricular assist devices lend well to emergent percutaneous placement in the cardiac catheterization lab or via surgical access to axillary or femoral arteries. ECMO has been demonstrated to improve in-hospital outcomes in a variety of acute heart failure scenarios, including cardiac arrest (when coupled with therapeutic hypothermia and early reperfusion).…”

“…ECMO also oxygenates blood, and therefore has utility in pulmonary and cardiopulmonary failure that can complicate cardiac arrest. 5 An algorithmic approach for the selection and management of circulatory assist devices is imperative for optimizing outcomes in cardiac arrest patients. In the absence of randomized trial data, their application should be made on an individual patient basis for OHCA patients with a good chance for neurological recovery by American Heart Association guidelines, weighing potential benefits against adverse complications and resource implications.…”

Strategies for Left Ventricular Decompression During Venoarterial Extracorporeal Membrane Oxygenation - A Narrative Review

“…The Impella 2.5 features a 12.5-F pump capable of generating a flow rate of 2.5 L/min, whereas the Impella CP is a 14-F pump capable of up to 4 L/min flow. [93][94][95][96] Addition of an Impella to VA-ECMO improves pulmonary perfusion and oxygenation and relieves postcapillary pulmonary hypertension. Eliet et al 90 demonstrated increased pulmonary artery Doppler velocity time integral and end-tidal carbon dioxide concentration, with lower left ventricular end diastolic dimensions on echocardiography, as Impella flow was increased in patients receiving both VA-ECMO and Impella support.…”