ADMIT(tance) ONE: Real-Time Hemodynamics in Mechanical Circulatory Support Devices

Temporary mechanical circulatory support (tMCS) devices are increasingly used to support patients through cardiogenic shock, high-risk percutaneous and surgical interventions and as a bridge to cardiac transplantation or durable MCS. 1 Schrage B Becher PM Goßling A et al. Temporal trends in incidence, causes, use of mechanical circulatory support and mortality in cardiogenic shock. ESC Heart Failure. 2021; 8: 1295-1303 Crossref PubMed Scopus (43) Google Scholar , 2 Bricker RS Glorioso TJ Jawaid O et al. Temporal trends and site variation in high-risk coronary intervention and the use of mechanical circulatory support: insights from the Veterans Affairs Clinical Assessment Reporting and Tracking (CART) program. J Am Heart Assoc. 2019; 8e014906 Crossref PubMed Scopus (10) Google Scholar , 3 Valdivia D Singhal P Hashmi S et al. Heart transplant outcomes and trends in pre-transplant Impella use. J Heart Lung Transplant. 2022; 41: S205 Abstract Full Text Full Text PDF Google Scholar These devices improve hemodynamics in a variety of ways, either by optimizing loading conditions to enhance native cardiovascular function (ie, afterload reduction with intra-aortic balloon pumps) or by adding to native cardiovascular output (ie, transvalvular microaxial flow pumps). Despite the obvious theoretical benefits of these devices, the interaction between native cardiovascular function and tMCS devices is complex and challenging to appreciate in real time. As a result, clinicians frequently encounter challenges while both escalating and de-escalating tMCS support. Use of traditional hemodynamic-monitoring tools such as a pulmonary artery catheter may help to resolve some of these difficulties but have their own well-recognized limitations. 4 Saxena A Garan AR Kapur NK et al. Value of hemodynamic monitoring in patients with cardiogenic shock undergoing mechanical circulatory support. Circulation. 2020; 141: 1184-1197 Crossref PubMed Scopus (101) Google Scholar Modification of a Transvalvular Microaxial Flow Pump for Instantaneous Determination of Native Cardiac Output and VolumeJournal of Cardiac FailureVol. 29Issue 10PreviewManagement of mechanical circulatory support (MCS) devices for cardiogenic shock (CS) in the setting of acute myocardial infarction or advanced heart failure can be quite variable on the basis of local or regional practice patterns as well as on operator preference. Despite the increased use of percutaneous MCS devices such as the Impella device (Abiomed; Danvers, MA),1 there is a dearth of evidence concerning when to wean or escalate hemodynamic support in this fragile population of patients.2 This, in part, plays a significant role in the variability of the ways in which the Impella pump is used. Full-Text PDF Open Access