title: Mechanical circulatory assist devices: a primer for critical care and emergency physicians.
abstract: Mechanical circulatory assist devices are now commonly used in the treatment of severe heart failure as bridges to cardiac transplant, as destination therapy for patients who are not transplant candidates, and as bridges to recovery and "decision-making". These devices, which can be used to support the left or right ventricles or both, restore circulation to the tissues, thereby improving organ function. Left ventricular assist devices (LVADs) are the most common support devices. To care for patients with these devices, health care providers in emergency departments (EDs) and intensive care units (ICUs) need to understand the physiology of the devices, the vocabulary of mechanical support, the types of complications patients may have, diagnostic techniques, and decision-making regarding treatment. Patients with LVADs who come to the ED or are admitted to the ICU usually have nonspecific clinical symptoms, most commonly shortness of breath, hypotension, anemia, chest pain, syncope, hemoptysis, gastrointestinal bleeding, jaundice, fever, oliguria and hematuria, altered mental status, headache, seizure, and back pain. Other patients are seen for cardiac arrest, psychiatric issues, sequelae of noncardiac surgery, and trauma. Although most patients have LVADs, some may have biventricular support devices or total artificial hearts. Involving a team of cardiac surgeons, perfusion experts, and heart-failure physicians, as well as ED and ICU physicians and nurses, is critical for managing treatment for these patients and for successful outcomes. This review is designed for critical care providers who may be the first to see these patients in the ED or ICU.
authors.affiliation: Department of Critical Care Medicine, Mayo Clinic Hospital, 5777 E. Mayo Blvd, Phoenix, AZ, 85054, USA. sen.ayan@mayo.edu.
authors.forename: Ayan
authors.initials: A
authors.lastname: Sen
authors.affiliation: Department of Critical Care Medicine, Mayo Clinic Hospital, 5777 E. Mayo Blvd, Phoenix, AZ, 85054, USA.
authors.forename: Joel S
authors.initials: JS
authors.lastname: Larson
authors.affiliation: Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA.|Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Kianoush B
authors.initials: KB
authors.lastname: Kashani
authors.affiliation: Department of Critical Care Medicine, Mayo Clinic Hospital, 5777 E. Mayo Blvd, Phoenix, AZ, 85054, USA.
authors.forename: Stacy L
authors.initials: SL
authors.lastname: Libricz
authors.affiliation: Department of Critical Care Medicine, Mayo Clinic Hospital, 5777 E. Mayo Blvd, Phoenix, AZ, 85054, USA.
authors.forename: Bhavesh M
authors.initials: BM
authors.lastname: Patel
authors.affiliation: Department of Critical Care Medicine, Mayo Clinic Jacksonville, Florida, USA.
authors.forename: Pramod K
authors.initials: PK
authors.lastname: Guru
authors.affiliation: Division of Cardiovascular and Thoracic Surgery, Mayo Clinic Hospital, Phoenix, Arizona, USA.
authors.forename: Cory M
authors.initials: CM
authors.lastname: Alwardt
authors.affiliation: Division of Cardiovascular and Thoracic Surgery, Mayo Clinic Hospital, Phoenix, Arizona, USA.
authors.forename: Octavio
authors.initials: O
authors.lastname: Pajaro
authors.affiliation: Department of Critical Care Medicine, Mayo Clinic Hospital, 5777 E. Mayo Blvd, Phoenix, AZ, 85054, USA.
authors.forename: J Christopher
authors.initials: JC
authors.lastname: Farmer
mesh_terms: D058186:Acute Kidney Injury / Q000150:complications / Q000209:etiology; D002305:Cardiac Tamponade / Q000150:complications / Q000209:etiology; D003657:Decision Making; D003937:Diagnosis, Differential; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006352:Heart Ventricles / Q000503:physiopathology / Q000637:transplantation; D006353:Heart-Assist Devices / Q000009:adverse effects* / Q000592:standards*; D006439:Hemodynamics / Q000502:physiology; D006461:Hemolysis / Q000502:physiology; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration; D011030:Pneumothorax / Q000150:complications / Q000209:etiology; D013927:Thrombosis / Q000150:complications / Q000209:etiology; D014180:Transplantation / Q000295:instrumentation / Q000379:methods; D016896:Treatment Outcome
keywords: Biventricular assist device; Cardiac arrest; Device failure; Gastrointestinal bleeding; Hemodynamic; Hypotension; Mechanical circulatory assist devices; Sepsis; Shortness of breath; Total artificial heart