title: Temporary Mechanical Circulatory Support in Cardiac Critical Care: A State of the Art Review and Algorithm for Device Selection.
abstract: With more than 60 years of continuous development and improvement, a variety of temporary mechanical circulatory support (MCS) devices and implantation strategies exist, each with unique advantages and disadvantages. A thorough understanding of each available device is essential for optimizing patient outcomes in a fiscally responsible manner. In this state of the art review we examine the entire range of commonly available peripheral and centrally cannulated temporary MCS devices, including intra-aortic balloon pumps, the Impella (Abiomed, Danvers, MA) family of microaxial pumps, the TandemHeart (CardiacAssist Inc, Pittsburg, PA) pump and percutaneous cannulas, centrally cannulated centrifugal pumps such as the CentriMag (Thoratec Corp, Pleasanton, CA/St Jude Medical, St Paul, MN/Abbott Laboratories, Abbott Park, IL) and Rotaflow (Maquet Holding BV & Co KG, Rastatt Germany), and extracorporeal membrane oxygenation. Several factors need detailed consideration when contemplating MCS in any given patient, mandating a balanced, algorithmic approach for these sick patients. In this review we describe our approach to MCS, and emphasize the need for multidisciplinary input to consider patient-related, logistical, and institutional factors. Evidence is summarized and referenced where available, but because of the lack of high-quality evidence, current best practice is described. Future directions for investigation are discussed, which will better define patient and device selection, and optimize MCS-specific patient care protocols.
authors.affiliation: Divisions of Cardiac Surgery and Critical Care Medicine, Western University / London Health Sciences Centre, London, Ontario, Canada. Electronic address: davenagpal@gmail.com.
authors.forename: A Dave
authors.initials: AD
authors.lastname: Nagpal
authors.affiliation: Department of Surgery, Sections of Cardiac Surgery and Critical Care, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba / St Boniface General Hospital, Winnipeg, Manitoba, Canada.
authors.forename: Rohit K
authors.initials: RK
authors.lastname: Singal
authors.affiliation: Department of Surgery, Sections of Cardiac Surgery and Critical Care, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba / St Boniface General Hospital, Winnipeg, Manitoba, Canada.
authors.forename: Rakesh C
authors.initials: RC
authors.lastname: Arora
authors.affiliation: Department of Surgery, Montreal Heart Institute and Department of Critical Care, Hospital du Sacre Coeur de Montreal, University of Montreal, Montreal, Québec, Canada.
authors.forename: Yoan
authors.initials: Y
authors.lastname: Lamarche
mesh_terms: D000465:Algorithms; D003325:Coronary Care Units; D003422:Critical Care / Q000379:methods*; D015199:Extracorporeal Membrane Oxygenation / Q000295:instrumentation*; D006333:Heart Failure / Q000628:therapy*; D006353:Heart-Assist Devices; D006801:Humans