Enrique Gongora1, Erik Orozco1, Charles Hoopes2. 1. Department of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA. 2. Department of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA. choopes@uabmc.edu.
Abstract
PURPOSE OF REVIEW: The available platforms for temporary circulatory support (TCS) have expanded to include impeller technologies in addition to the traditional approaches with centrifugal pumps and intra-aortic counterpulsation. We review the evidence for competing technologies, relative risk, and benefit of individual TCS platforms and provide a consensus opinion in the context of our institutional experience. RECENT FINDINGS: Trans-aortic axial flow devices (Impella) have significantly impacted the support of patients with cardiogenic shock. Despite the absence of prospective randomized data, the use of both percutaneous and surgical Impella devices is ubiquitous among heart failure centers and rapidly evolving. Extracorporeal centrifugal pumps remain the technology of last resort. Despite the increasing use of new TCS platforms, there is little empirical evidence that outcomes have been impacted. Increasingly, systems of care-rather than technology-are seen as the more important variable in the management of patients with cardiogenic shock.
PURPOSE OF REVIEW: The available platforms for temporary circulatory support (TCS) have expanded to include impeller technologies in addition to the traditional approaches with centrifugal pumps and intra-aortic counterpulsation. We review the evidence for competing technologies, relative risk, and benefit of individual TCS platforms and provide a consensus opinion in the context of our institutional experience. RECENT FINDINGS: Trans-aortic axial flow devices (Impella) have significantly impacted the support of patients with cardiogenic shock. Despite the absence of prospective randomized data, the use of both percutaneous and surgical Impella devices is ubiquitous among heart failure centers and rapidly evolving. Extracorporeal centrifugal pumps remain the technology of last resort. Despite the increasing use of new TCS platforms, there is little empirical evidence that outcomes have been impacted. Increasingly, systems of care-rather than technology-are seen as the more important variable in the management of patients with cardiogenic shock.
Entities:
Keywords:
Cardiogenic shock; ECMO; Impella; Temporary circulatory support
Authors: Alexandra E Sperry; Matthew Williams; Pavan Atluri; Wilson Y Szeto; Marisa Cevasco; Christian A Bermudez; Michael A Acker; Michael Ibrahim Journal: Curr Heart Fail Rep Date: 2021-05-06