How New Support Devices Change Critical Care Delivery

Abstract

Mechanical support devices are used to support failing cardiac, respiratory, or both systems. Since Gibbon developed the cardiopulmonary bypass in 1953, collaborative efforts by medical centers, bioengineers, industry, and the National Institutes of Health have led to development of mechanical devices to support heart, lung, or both. These devices are used as a temporary or long-term measures for acute collapse of circulatory system and/or respiratory failure. Patients are managed on these support devices as a bridge to recovery, bridge to long term devices, or bridge to transplant. The progress in development of these devices has improved mortality and quality of life in select groups of patients. Care of these patients requires a multidisciplinary team approach, which includes cardiac surgeons, critical care physicians, cardiologists, pulmonologists, nursing staff, and perfusionists. Using a team approach improves outcomes in these patients.

Keywords: critical care management; mechanical circulatory support devices; role of multidisciplinary team.

Figure 1.

TandemHeart (CardiacAssist, Inc.) percutaneous placed short-term left ventricular assist device. Reprinted with permission.

Figure 2.

(A) Effect of Impella^® on cardiac output. (B) Position of Impella® inside the left ventricle. © 2018 Abiomed, Inc.

Figure 3.

The SynCardia Total Artificial Heart is used in end-stage biventricular heart failure and is approved by the FDA as a bridge to heart transplantation. Courtesy of syncardia.com

Figure 4.

The NuPulse cardiovascular intravascular assist system provides long-term hemodynamic support in advanced heart failure and is intended for use as a bridge to transplant or bridge to recovery. Reprinted with permission.

Figure 5.

Mechanical circulatory devices are best implanted by hospitals with multidisciplinary teams and specialized units experienced in caring for this exceedingly complex and critical patient population.

Figure 6.

Ethics teams must uphold and ensure the patient's right to decision making, beneficence of care provided, the physician's responsibility to do no harm, and fair use of resources.