Treatment of cardiogenic shock with the Hemopump left ventricular assist device.
A multiinstitutional study is in progress to evaluate the Hemopump in the treatment of cardiogenic shock. Fifty-three patients with refractory cardiogenic shock were selected for Hemopump assistance. The hemodynamic definition of cardiogenic shock included (1) a cardiac index of less than 2.0 L.min-1.m-2, (2) pulmonary capillary wedge pressure of greater than 18 mm Hg, and (3) a systolic blood pressure of less than 90 mm Hg or a left ventricular work index of less than 1,500 g-m.m-2.min-1. The Hemopump was successfully inserted in 41 of 53 patients (77.3%). A significant improvement in the hemodynamic status was seen during Hemopump assistance. A minimal level of hemolysis was observed. No leg ischemia was observed. The 30-day overall survival of the Hemopump group was 31.7%. Criteria establishing indications for use and clinical utility are proposed. We conclude that the Hemopump provides significant hemodynamic support of the patient in cardiogenic shock allowing for recovery from ventricular stunning in marginal ventricles, and that in select patients the Hemopump may offer a major improvement in survival over conventional therapy.
Wampler
R K
RK
Nimbus, Inc, Rancho Cordova, California.
Frazier
O H
OH
Lansing
A M
AM
Smalling
R W
RW
Nicklas
J M
JM
Phillips
S J
SJ
Guyton
R A
RA
Golding
L A
LA
D002302:Cardiac Output; D004867:Equipment Design; D005260:Female; D006353:Heart-Assist Devices; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008297:Male; D010976:Platelet Count; D011669:Pulmonary Wedge Pressure; D012770:Shock, Cardiogenic / Q000097:blood / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D015996:Survival Rate
D006454:Hemoglobins