SCCM Resource Library-An Overview of Acute Mechanical Circulatory Support

Pdf Summary

The document provides an overview of acute mechanical circulatory support (MCS), highlighting its history, development, and current technologies. It begins with the pioneering work of Dr. John Gibbon in the 1930s, who conceptualized the use of a heart-lung machine while witnessing the limitations of medical interventions for critically ill patients. This eventually led to the development of the heart-lung machine, first successfully used in 1953. Meanwhile, Dr. Adrian Kantrowitz developed the concept of counterpulsation, leading to the intra-aortic balloon pump (IABP), which entered clinical use in 1967.<br /><br />The document explains cardiogenic shock, a state where the heart fails to meet the body’s metabolic demands, and reviews various MCS devices designed to support the heart significantly under pressure. The IABP remains a widely used device due to its ease of use and low risk profile. It operates through counterpulsation—improving myocardial perfusion and reducing left ventricular afterload.<br /><br />The text covers other MCS devices like the Impella and TandemHeart, which provide short-term left ventricular assist. The Impella, a percutaneous pump, aids patients experiencing acute myocardial infarction or cardiogenic shock, although it can induce hemolysis.<br /><br />The document further delves into short-term right ventricular assist devices tailored for right heart failures, such as Impella RP, TandemHeart RVAD, and the TamdemLife Protek Duo, noting mixed outcomes and emphasizing their varied effectiveness based on patient conditions.<br /><br />Finally, the document discusses venoarterial extracorporeal membrane oxygenation (VA-ECMO), designed for more extensive cardiopulmonary support when both heart and lung failures occur. It outlines clinical management principles, such as monitoring oxygenation and left ventricular (LV) pulsatility, and navigating complications like limb ischemia and anticoagulation.<br /><br />Overall, the document emphasizes the importance of selecting the appropriate MCS device tailored to each patient's needs, reflecting ongoing innovation and research in the field.

Asset Subtitle

Cardiovascular, 2020, 3:20:00

Asset Caption

This is a complimentary chapter from the textbook, Current Concepts in Adult Critical Care 2020), titled "An Overview of Acute Mechanical Circulatory Support."

Learning Objectives:

Review the commonly used devices for acute mechanical circulatory support.
Discuss the key management principles of these devices.

Meta Tag

Content Type Book Chapter

Knowledge Area Cardiovascular

Knowledge Level Intermediate

Knowledge Level Advanced

Membership Level Select

Membership Level Professional

Membership Level Associate

Tag Extracorporeal Life Support

Tag Cardiothoracic Critical Care

Year 2020

Keywords

acute mechanical circulatory support

heart-lung machine

intra-aortic balloon pump

cardiogenic shock

Impella

TandemHeart

right ventricular assist devices

venoarterial extracorporeal membrane oxygenation

cardiopulmonary support

Dr. John Gibbon

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