【体外膜肺ECMO精品课件】 Healing the Heart When Failure is Not an Option.pptVIP

Management Most importantly, treatment is to prevent or stop the failure of other organs that are dependent on blood flow from the heart. This can be done medically or with mechanical devices. Intra-Aortic Balloon pump Device placed via the femoral artery (in the leg) to increase heart blood flow. Pros: Can be placed and removed by a catheter. Will allow increased heart and brain blood flow Cons: Does not increase the amount of blood pumped by the heart Has never been shown to improve survival. Tandem Heart Centrifugal flow pump placed percutaneously Designed to augment left ventricular output and rest left ventricle Can augment cardiac output up to 5 LPM Pros: Can fully augment left ventricular cardiac output Placed and removed percutaneously Cons: Must have skilled person to place the cannula trans-septal Cannula position is difficult to control and cannula can migrate Tandem Heart Many case studies and retrospective reviews to show efficacy, but no PRCT to show efficacy versus convertional therapy. Theoretical advantage to allowing the left ventricle to rest and provide the body with support. No mechanism to deal with right ventricular failure. Trial starting now to determine efficacy versus other devices Impella Axial flow device 2.5- 5.0 L/min Active forward flow Single Vascular access 5 Minute setup\ Percutaneous or surgical cut-down for placement Multiple configurations possible Operation independent of cardiac function or rhythm Impella Console Impella LD/LP 5.0 Impella LP2.5 Pumps Implantation Impella CP Impella CP Impella RP New Technology Investigational Myocardial Protection Hemodynamic Support Inflow (ventricle) Outflow (aortic root) aortic valve O2 Demand O2 Supply Cardiac Power Output EDV, EDP AOP Flow Myocardial Protection Systemic Hemodynamic Support Physiology of Impella * Impella Unloading Effect ECMO Extracorporeal Membraneous Oxygenation Blood is removed from the ven