Mechanical circulatory devices in acute heart failure. Issue 4 (August 2018)

• Record Type: Journal Article
• Authors: Pineton de Chambrun, Marc; Bréchot, Nicolas; Combes, Alain
• Is Part Of: Current opinion in critical care. Volume 24:Issue 4(2018)
• Publication Date: 2018-08
• Subjects: cardiogenic shock -- intra-aortic balloon pump -- mechanical circulatory support devices -- percutaneous active mechanical circulatory support devices -- temporary circulatory support -- venoarterial extracorporeal membrane oxygenation; Critical care medicine -- Periodicals; 616.028
• DOI: 10.1097/MCC.0000000000000520
• Languages: English
• ISSNs: 1070-5295

Abstract

Abstract : Purpose of review: Temporary circulatory support (TCS) with short-term mechanical circulatory support (MCS) devices is increasingly used as a salvage therapy for patients with refractory cardiogenic shock. This article provides an overview of current devices, their indications and management, and discusses results of recent case series and trials. Recent findings: Percutaneous active MCS devices (Impella, TandemHeart…) and venoarterial extracorporeal membrane oxygenation (VA-ECMO) are utilized as a bridge to 'decision' that includes weaning after cardiac function recovery, transplantation, long-term MCS and withdrawal in case of futility. VA-ECMO is considered the first-line TCS since it allows rapid improvement in oxygenation, is less expensive, and is also suitable for patients with biventricular failure. Combining Impella or intra-aortic balloon pump support with ECMO might decrease left ventricular pressure and improve outcomes. Sepsis-associated cardiomyopathy, massive pulmonary embolism, arrhythmic storm and Takotsubo-like cardiomyopathy are among emerging indications for TCS. Summary: TCS have become the cornerstone of the management of patients with cardiogenic shock, although the evidence supporting their efficacy is limited. VA-ECMO is considered the first-line option, with a growing number of accepted and emerging indications. Randomized clinical trials are now needed to determine the respective place of different MCS devices in cardiogenic shock treatment strategies.