TY - JOUR
T1 - Mechanical circulatory assist devices
T2 - A primer for critical care and emergency physicians
AU - Sen, Ayan
AU - Larson, Joel S.
AU - Kashani, Kianoush B.
AU - Libricz, Stacy L.
AU - Patel, Bhavesh M.
AU - Guru, Pramod K.
AU - Alwardt, Cory M.
AU - Pajaro, Octavio
AU - Farmer, J. Christopher
N1 - Publisher Copyright:
© 2016 Sen et al.
PY - 2016/6/25
Y1 - 2016/6/25
N2 - Mechanical circulatory assist devices are now commonly used in the treatment of severe heart failure as bridges to cardiac transplant, as destination therapy for patients who are not transplant candidates, and as bridges to recovery and "decision-making". These devices, which can be used to support the left or right ventricles or both, restore circulation to the tissues, thereby improving organ function. Left ventricular assist devices (LVADs) are the most common support devices. To care for patients with these devices, health care providers in emergency departments (EDs) and intensive care units (ICUs) need to understand the physiology of the devices, the vocabulary of mechanical support, the types of complications patients may have, diagnostic techniques, and decision-making regarding treatment. Patients with LVADs who come to the ED or are admitted to the ICU usually have nonspecific clinical symptoms, most commonly shortness of breath, hypotension, anemia, chest pain, syncope, hemoptysis, gastrointestinal bleeding, jaundice, fever, oliguria and hematuria, altered mental status, headache, seizure, and back pain. Other patients are seen for cardiac arrest, psychiatric issues, sequelae of noncardiac surgery, and trauma. Although most patients have LVADs, some may have biventricular support devices or total artificial hearts. Involving a team of cardiac surgeons, perfusion experts, and heart-failure physicians, as well as ED and ICU physicians and nurses, is critical for managing treatment for these patients and for successful outcomes. This review is designed for critical care providers who may be the first to see these patients in the ED or ICU.
AB - Mechanical circulatory assist devices are now commonly used in the treatment of severe heart failure as bridges to cardiac transplant, as destination therapy for patients who are not transplant candidates, and as bridges to recovery and "decision-making". These devices, which can be used to support the left or right ventricles or both, restore circulation to the tissues, thereby improving organ function. Left ventricular assist devices (LVADs) are the most common support devices. To care for patients with these devices, health care providers in emergency departments (EDs) and intensive care units (ICUs) need to understand the physiology of the devices, the vocabulary of mechanical support, the types of complications patients may have, diagnostic techniques, and decision-making regarding treatment. Patients with LVADs who come to the ED or are admitted to the ICU usually have nonspecific clinical symptoms, most commonly shortness of breath, hypotension, anemia, chest pain, syncope, hemoptysis, gastrointestinal bleeding, jaundice, fever, oliguria and hematuria, altered mental status, headache, seizure, and back pain. Other patients are seen for cardiac arrest, psychiatric issues, sequelae of noncardiac surgery, and trauma. Although most patients have LVADs, some may have biventricular support devices or total artificial hearts. Involving a team of cardiac surgeons, perfusion experts, and heart-failure physicians, as well as ED and ICU physicians and nurses, is critical for managing treatment for these patients and for successful outcomes. This review is designed for critical care providers who may be the first to see these patients in the ED or ICU.
KW - Biventricular assist device
KW - Cardiac arrest
KW - Device failure
KW - Gastrointestinal bleeding
KW - Hemodynamic
KW - Hypotension
KW - Mechanical circulatory assist devices
KW - Sepsis
KW - Shortness of breath
KW - Total artificial heart
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U2 - 10.1186/s13054-016-1328-z
DO - 10.1186/s13054-016-1328-z
M3 - Review article
C2 - 27342573
AN - SCOPUS:84975702606
SN - 1364-8535
VL - 20
JO - Critical Care
JF - Critical Care
IS - 1
M1 - 153
ER -