Circulatory support in the intensive care unit

Abstract

Since the late 90s, technological advances have led to an improvement in survival rates in patients receiving long-term circulatory support for terminal heart failure. As a result, there has been an increased interest in all circulatory support techniques. This review outlines the main support devices currently available in France, their respective advantages and disadvantages, and discusses the management of patients who are suffering from severe cardiogenic shock unresponsive to optimal medical treatment. For these patients, circulatory support can be split into two stages : (1) The rapid implementation of support, focusing on the easier-to-implant and less expensive devices, which will allow time (several weeks) for one of the following : myocardial recovery, implementation of a longer-term support solution, and a heart transplant. These devices include intraaortic balloon pump, Impella® system (left ventricular axial pump), and extracorporeal membrane oxygenation (EMCO). (2) After careful consideration of the possibility of either myocardial recovery or a heart transplant, implementation of long-term cardiac support (for several months or even a few years) via an “artificial heart” may allow patients to return home and regain a certain amount of normality to their life. This is an exceptional treatment; artificial hearts are only implanted in specialized centers, providing the necessary multidisciplinary expertise. There are a number of artificial heart models available, including those that provide monoventricular (left) or biventricular support, those implanted directly into the chest (excluding the power supply) (e.g., CardioWest®), and others that are external to the patient, which are connected to the heart via cannulae. New, completely implantable (apart from the power supply), less noisy axial or centrifugal continuous flow pumps are being developed, representing a significant advance in the treatment of left ventricular failure.