ECMO, VAD, Impella, and IABP: Primer on Mechanical Circulatory Support Devices

Vascular and interventional physicians are routinely caring for some of the sickest patients in the hospital, including those with cardiopulmonary collapse. A foundational comprehension of mechanical circulatory devices is necessary in these situations. Within this article, we will review the indications, procedural steps, management, clinical follow up, and outcomes of 4 types of mechanical circulatory support devices: Extracorporeal membrane oxygenation (ECMO), ventricular assist devices (VAD), Impella, and intra-aortic balloon pumps (IABP). ECMO is a large-bore cannulation system serving patients in respiratory and/or combination of cardiorespiratory collapse. It requires constant monitoring and adjustment with a wide range of benefits in appropriately selected patients in the hospital. VADs are surgically-implanted devices for more long-term ventricular support, often extending the survival of end-stage heart failure or bridging to transplant. Impella and IABPs, by comparison, are smaller intravascular devices that aid in short-term ventricular off-loading and improve perfusion. They provide hemodynamic stabilization in the setting of acute cardiac insult or surgery, prior to either organ recovery or transition to more definitive therapy. All of these devices come with unique considerations and potential complications. This article will serve as a guide in evaluating patients for device candidacy, procedural placement, troubleshooting, management in the perioperative setting, complication surveillance, and clinical outcomes/follow-up.