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Mechanical Circulatory Support For Cardiogenic Shock Post AMI Asghar Khaghani Royal Brompton and Harefield NHS Trust

Mechanical Circulatory Support For Cardiogenic Shock Post AMI Asghar Khaghani Royal Brompton and Harefield NHS Trust. Mechanical Circulatory Support Cardiogenic Shock Post AMI. Difficulties:. Delayed Referral Cardiac Arrest/ Unknown neurological state Ventilated

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Mechanical Circulatory Support For Cardiogenic Shock Post AMI Asghar Khaghani Royal Brompton and Harefield NHS Trust

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  1. Mechanical Circulatory Support For Cardiogenic Shock Post AMI Asghar Khaghani Royal Brompton and Harefield NHS Trust

  2. Mechanical Circulatory Support Cardiogenic Shock Post AMI Difficulties: • Delayed Referral • Cardiac Arrest/ Unknown neurological state • Ventilated • Pyrexia of unknown origin • Failed thrombolysis . Risk of bleeding

  3. Mechanical Circulatory Support Cardiogenic Shock Post AMI • Majority have had PCI and on Clopidogrel • Not tolerant of Inotropes • Have other co-morbidities • Have had previous surgical re-vascularisation • Multi organ dysfunction

  4. MCS Cardiogenic Shock Post AMI Options: • IABP • Percutaneous ventricular assist devices • ECMO • Short term devices • ? Upgrades to Long term devices

  5. Cardiogenic Shock Post AMI IABP • - can initially stabilise the patient • - may not provide enough support • - requires a certain level of LV function • - may be limited by persistent tachycardia / tachyarrythmias

  6. Impella 2.5 – 9F shaft diameter - 12F pump rotor - 2.5 Litres/min - 5 days 5 – 9F shaft diameter - 21F pump rotor - 5 Litres/min - 10 days

  7. Reitan Catheter pump • 10 F -> opens to 14F

  8. Removes oxygenated blood from LA via transseptal cannula in the femoral vein Returns blood via femoral artery Reduces preload Increases MAP Continuous flow 21 F 14 days TandemHeart pVAD

  9. ECMO for Cardiogenic Shock Post AMI • Easy and fast to commence • Less bleeding • Less costly • Easy to upgrade to a VAD • Moblisation is difficult • Pulmonary congestion • Inadequat flow

  10. Short term Devices for Cardiogenic Shock Post AMI • Easy to insert • CPB not required • Less bleeding • Less costly • Gives time for further assessment

  11. CentriMag® MagLev Ventricular Assist System: Pump Motor Console

  12. Levitronix for End Stage Cardiac FailureLeft Ventricular Support

  13. Levitronix for End Stage Cardiac FailureBiventricular Support

  14. CentriMag® in action

  15. Short term Devices for Cardiogenic Shock Post AMI • Bridge to recovery • Bridge to surgery • Bridge to a long term VAD • Bridge to urgent heart transplantation

  16. Areas of Concern • Transfer of Patients to VAD units • Ventilated patients • Infection • Bleeding • Type of intervention • Multi organ dysfunction • Shortage of donor hearts!

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