Mechanical circulatory assist devices: A primer for critical care and emergency physicians

Ayan Sen, Joel S. Larson, Kianoush B. Kashani, Stacy L. Libricz, Bhavesh M. Patel, Pramod K. Guru, Cory M. Alwardt, Octavio Pajaro, J. Christopher Farmer

Research output: Contribution to journalReview articlepeer-review

38 Scopus citations

Abstract

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.

Original languageEnglish (US)
Article number153
JournalCritical Care
Volume20
Issue number1
DOIs
StatePublished - Jun 25 2016

Keywords

  • Biventricular assist device
  • Cardiac arrest
  • Device failure
  • Gastrointestinal bleeding
  • Hemodynamic
  • Hypotension
  • Mechanical circulatory assist devices
  • Sepsis
  • Shortness of breath
  • Total artificial heart

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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