Physiology of the Assisted Circulation in Cardiogenic Shock, a State of the Art Perspective

Publication date: Available online 9 November 2019Source: Canadian Journal of CardiologyAuthor(s): Julien Guihaire, Francois Haddad, Mita Hoppenfeld, Myriam Amsallem, Jeffrey W. Christle, Clark Owyang, Khizer Shaikh, Joe L. HsuAbstractMechanical circulatory support (MCS) has made rapid progress over the last three decades. This was driven by the need to develop acute and chronic circulatory support as well as by the limited organ availability for heart transplantation. The growth of MCS was also driven by the use of extracorporeal membrane oxygenation (ECMO) after the worldwide H1N1 influenza outbreak of 2009. The majority of mechanical pumps (ECMO and left ventricular assist devices) are currently based on continuous flow pump design. It is interesting to note that in the current era, we have reverted from the mammalian pulsatile heart back to the continuous flow pumps seen in our simple multicellular ancestors. This review will highlight key physiological concepts of the assisted circulation from its effects on cardiac dynamic to principles of cardiopulmonary fitness. We will also examine the physiological principles of the ECMO-assisted circulation, anticoagulation and the hemocompatibility challenges that arise when the blood is exposed to a foreign mechanical circuit. Finally, we conclude with a perspective on smart design for future development of devices used for MCS.
Source: Canadian Journal of Cardiology - Category: Cardiology Source Type: research

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