Using mechanical circulatory support
Gain an understanding of extracorporeal circulatory support and when to use it.
In this video, from our Resuscitation Essentials course, we'll look at mechanical circulatory support devices, as well as important considerations about when they're appropriate to use and when they are not!
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Learn all about supporting patient circulation, manual compressions, mechanical circulatory support, and the methods used to optimize their effects in our Resuscitation Essentials course. By the end of this course, you'll master a step-by-step approach for managing patients near to, or experiencing, cardiac arrest in any environment.
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[00:00:00] Intraaortic balloon pumps have been used for many years to provide support during cardiogenic shock. They augment diastolic filling pressure by expanding in the aorta during diastole. In addition, they may increase cardiac output slightly by decreasing afterload with deflation during systole. In general, they provide about one to two liters a minute of augmented cardiac output. Percutaneous ventricular assist devices have been developed more recently to provide more flow to
[00:00:30] support cardiac output, up to several liters per minute. Cardiopulmonary bypass is able to completely replace the function of the heart and lungs, however, it's generally available only in the operating room environment. Extracorporeal membranous oxygenation or ECMO devices are able to provide biventricular support, at flow rates which may be adequate to provide perfusion and have been described as a supportive therapy, for patients in cardiac arrest, as a bridge toward intervention or recovery. These devices function
[00:01:00] in a similar manner to cardiopulmonary bypass but are more portable and therefore more available for use in the emergency setting. It's important to remember that mechanical circulatory support provides temporary support, as a bridge for patients in whom an endpoint is clear, for example, a disease process in which recovery is expected or definitive treatment is available. Examples may include cardiac revascularization, recovery from a transient disease process like
[00:01:30] some types of myocarditis or recovery from a toxic overdose or as a bridge to organ transplantation. Patients are unlikely to benefit from these therapies if they have multi-organ system failure, irreversible conditions or terminal diseases or with any other contraindications like the inability to anticoagulate.