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Mechanical Circulatory Support in the New Era: An Overview

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Annual Update in Intensive Care and Emergency Medicine 2016

Part of the book series: Annual Update in Intensive Care and Emergency Medicine ((AUICEM))

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Abstract

Maximal medical therapy can no longer be seen as a justifiable end-point for refractory circulatory shock, at least in well-resourced health settings. Despite improvements in almost all other areas of cardiac and intensive care medicine, refractory cardiogenic shock, defined as cardiac and circulatory failure resulting in organ hypoperfusion [1], continues to have unacceptably high mortality and morbidity from the resultant multiple organ failure. Whilst primary cardiac pathology remains the leading cause of cardiogenic shock, acute cardiomyopathies secondary to conditions such as sepsis and toxic ingestion are not uncommon [2]. The conventional approach to supporting patients with circulatory shock includes reversal of underlying causes when feasible, mechanical ventilation, pharmacological hemodynamic support with or without intra-aortic balloon counter pulsation, renal replacement and other supportive therapy. Whilst mechanical circulatory support (MCS) has always been an attractive option when conventional approaches fail, technological limitations, suboptimal clinical application of available technology and resource limitations have all conspired against its more widespread use.

Recently, there is increasing application of extracorporeal membrane oxygenation (ECMO) technology to provide MCS in an incremental fashion either as peripheral or central venoarterial (VA)-ECMO or as univentricular or biventricular assist devices [3, 4]. The use of ECMO in cardiopulmonary resuscitation (CPR) is also expanding with experienced centers reporting favorable outcomes [5]. Other minimally invasive percutaneous ventricular assist devices (pVADs) have also been used in acute settings. Similarly, the implantable, durable, rotary blood pump-driven VADs have revolutionized the care of patients with chronic heart failure or those with acute heart failure who initially need to be stabilized on temporary MCS, and in whom cardiac recovery does not occur [6]. Although total artificial hearts have been used only sparsely, it is expected that their use will increase with the increasing heart failure population and rapid improvements in technology that are currently occurring [7].

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Authors and Affiliations

  1. School of Medicine, The University of Queensland, 4072, Brisbane, Queensland, Australia

    K. Shekar, S. D. Gregory & J. F. Fraser

  2. Innovative Cardiovascular Engineering and Technology Laboratory, Critical Care Research Group, The Prince Charles Hospital, 4032, Chermside, Queensland, Australia

    K. Shekar, S. D. Gregory & J. F. Fraser

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  1. K. Shekar
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  2. S. D. Gregory
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  3. J. F. Fraser
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Correspondence to K. Shekar .

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Editors and Affiliations

  1. Université libre de Bruxelles Dept. of Intensive Care, Erasme Hospital, Brussels, Belgium

    Jean-Louis Vincent

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Shekar, K., Gregory, S.D., Fraser, J.F. (2016). Mechanical Circulatory Support in the New Era: An Overview. In: Vincent, JL. (eds) Annual Update in Intensive Care and Emergency Medicine 2016. Annual Update in Intensive Care and Emergency Medicine. Springer, Cham. https://doi.org/10.1007/978-3-319-27349-5_17

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  • DOI: https://doi.org/10.1007/978-3-319-27349-5_17

  • Publisher Name: Springer, Cham

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