There are a number of devices used to provide hemodynamic support to patients with critical life-threatening conditions. These include ventricular assist devices, intra-aortic balloon pumps (IABPs) and the two types of devices we will be discussing in this article: percutaneous ventricular assist devices and extracorporeal membrane oxygenation (ECMO).
Overview Of ECMO
ECMO is an artificial life-support device that is used to keep a patient’s heart and lungs functioning. ECMO is an external machine (extracorporeal means outside of the body) that pumps blood out of the body to remove carbon dioxide and add oxygen before pumping the blood back into the body.
ECMO is used to assist patients with a number of conditions, including:
- Acute respiratory distress syndrome (ARDS)
- Before or recovering from a heart transplant
- Cardiac or respiratory failure
- Cardiogenic shock
- Coronavirus and influenza
- Heart attack
- Myocarditis
- Pneumonia
- Pulmonary embolism
- Pulmonary hypertension
- Septic shock
- Severe hypothermia
ECMO Advantages And Disadvantages
- It provides oxygenation.
- It can be placed quickly to avoid organ failure in critical patients.
- It does not provide left-ventricular unloading: a potential issue for patients with poor left-ventricle function.
- It is only a short-term support option (typically only used for a few days).
- Complications are common with ECMO.
Overview Of Impella®
The Impella® is a percutaneous ventricular assist device that pumps blood to the body, reproducing the function of the left ventricle. It is used in patients with coronary artery disease or heart failure, patients in cardiogenic shock, during or after cardiac surgery, or to support patients waiting for a heart transplant.
Impella® Advantages And Disadvantages
- It is a minimally invasive procedure that does not require heart surgery.
- It unloads the left ventricle, reducing pressure on the heart.
- It can be used for up to a week.
- It only provides left-ventricular support unless a right-ventricular device is also inserted.
- It does not provide oxygenation.
ECMO Vs. Impella®
While both temporary pumps have advantages and disadvantages, the decision on which device to use will be guided by the individual patient’s condition. Those who need circulation and oxygen support will receive ECMO. Doctors can consider the use of a ventricular assist device in patients who only require circulation support. Factors such as urgency (ECMO is the quickest way to prevent end-organ failure in acute scenarios), ventricular function and any other heart dysfunction will all play a role in device selection by the critical care team.
The team at Advanced Cardiovascular Specialists consists of North Louisiana’s leading experts in cardiovascular care. For more information or to schedule an appointment, please call our office at (318) 798-9400.