Clinical scenarios for use of transvalvular microaxial pumps in acute heart failure and cardiogenic shock - A European experienced users working group opinion.
- Schäfer A Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany. Electronic address: Schaefer.andreas@mh-hannover.de.
- Werner N Department of Cardiology, University Heart Center, Bonn, Germany.
- Westenfeld R Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Düsseldorf, Germany.
- Møller JE University Hospital Odense, Department of Cardiology, Odense, Denmark.
- Schulze PC Department of Cardiology, University of Jena, Jena, Germany.
- Karatolios K Department of Cardiology, University of Marburg, Marburg, Germany.
- Pappalardo F Department of Cardiothoracic Vascular Anesthesia and Intensive Care, Advanced Heart Failure and Mechanical Circulatory Support Program, San Raffaele Hospital, Vita Salute University, Milan, Italy.
- Maly J Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
- Staudacher D Department of Cardiology and Angiology I, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
- Lebreton G Department of Cardiovascular Surgery, Hospital Pitié-Salpêtrière, Paris, France.
- Delmas C Department of Cardiology, Rangueil University Hospital, Toulouse, France.
- Hunziker P Department of Cardiology, University Hospital Basel, Basel, Switzerland.
- Fritzenwanger M Department of Cardiology, University of Jena, Jena, Germany.
- Napp LC Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
- Ferrari M Department of Cardiology and Intensive Care Medicine, Dr. Horst Schmidt Hospital, Wiesbaden, Germany.
- Tarantini G Department of Cardiology, University of Padua, Padua, Italy.
- 2019-06-04
Published in:
- International journal of cardiology. - 2019
Cardiogenic shock
ECMO
Hemodynamics
Impella
LV function
Mechanical circulatory support
Europe
Extracorporeal Membrane Oxygenation
Heart Failure
Heart-Assist Devices
Hemodynamics
Humans
Intra-Aortic Balloon Pumping
Shock, Cardiogenic
English
For patients with myocardial infarct-related cardiogenic shock (CS), urgent percutaneous coronary intervention is the recommended treatment strategy to limit cardiac and systemic ischemia. However, a specific therapeutic intervention is often missing in non-ischemic CS cases. Though drug treatment with inotropes and/or vasopressors may be required to stabilize the patient initially, their ongoing use is associated with excess mortality. Coronary intervention in unstable patients often leads to further hemodynamic compromise either during or shortly after revascularization. Support devices like the intra-aortic balloon pump failed to improve clinical outcomes in infarct-related CS. Currently, more powerful and active hemodynamic support devices unloading the left ventricle such as transvalvular microaxial pumps are available and are being increasingly used. However, as for other devices large randomized trials are not yet available, and device use is based on registry data and expert consensus. In this article, a multidisciplinary group of experienced users of transvalvular microaxial pumps outlines the pathophysiological background on hemodynamic changes in CS, the available mechanical support devices, and current guideline recommendations. Furthermore, different hemodynamic situations in several case-based scenarios are used to illustrate candidate settings and to provide the theoretic and scientific rationale for left-ventricular unloading in these scenarios. Finally, organization of shock networks, monitoring, weaning, and typical complications and their prevention are discussed.
- Language
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- English
- Open access status
- hybrid
- Identifiers
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- DOI 10.1016/j.ijcard.2019.05.044
- PMID 31155332
- Persistent URL
- https://sonar.ch/global/documents/160186
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