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[Mechanical cardiac assist systems in intensive care]
1Abteilung Kardiologie und Pulmonologie, Universitäts-Kliniken, Göttingen.
Zeitschrift Fur Kardiologie
|January 1, 1994
Summary
Mechanical cardiac assist devices like the Intraaortal Balloon Pump (IABP) and percutaneous cardiopulmonary support (PCPS) aid patients with sudden death or cardiogenic shock. These devices improve survival rates in ischemic heart disease, but their effectiveness varies by condition.
Area of Science:
- Cardiovascular Medicine
- Medical Devices
- Cardiac Surgery
Context:
- Mechanical cardiac assist devices are crucial for managing sudden death, cardiogenic shock, severe coronary ischemia, and high-risk percutaneous transluminal coronary angioplasty (PTCA).
- Available devices include the Intraaortal Balloon Pump (IABP), implantable turbine pumps, percutaneous cardiopulmonary support (PCPS), centrifugal pumps, and total artificial hearts.
- Each device has specific indications, implantation methods, and clinical outcomes that influence their application in critical cardiac conditions.
Purpose:
- To review the indications and applications of various mechanical cardiac assist devices in managing acute cardiovascular conditions.
- To compare the effectiveness and limitations of different devices, such as IABP, turbine pumps, and PCPS, in specific clinical scenarios.
- To highlight the role of these devices in improving survival rates for conditions like ischemic cardiogenic shock and as support during high-risk procedures.
Summary:
- The Intraaortal Balloon Pump (IABP) is easily positioned and suitable for several days of use, significantly improving survival in ischemic cardiogenic shock from 20% to 60%, but is less effective for myocardial infarction without shock or high-risk PTCA.
- Implantable turbine pumps (e.g., Hemopump TM) offer varying flow rates and can be implanted percutaneously or via arteriotomy/thoracotomy, currently in testing phases for high-risk PTCA and CABG surgery.
- Percutaneous cardiopulmonary support (PCPS) offers complete circulatory replacement, ideal for cardiac arrest and high-risk PTCA, with studies showing a 6.9% mortality in PTCA and a 30% survival rate in circulatory arrest when rapidly deployed.
Impact:
- Mechanical cardiac assist devices, particularly IABP and PCPS, have demonstrated significant improvements in survival rates for critical cardiac conditions.
- The choice of device depends on the specific clinical indication, ranging from temporary support to complete circulatory replacement.
- Continued research and development in cardiac assist devices are essential for optimizing patient outcomes in complex cardiovascular emergencies and surgical procedures.