Pennington et al listed criteria for when to use a ventricular assist device (VAD) in a patient with cardiogenic shock after cardiac surgery or prior to heart transplant. The authors are from the St. Louis Medical Center.
Patient selection:
(1) intra-aortic balloon pump
(2) optimal preload
(3) cardiac index < 2.0 liters per square meter BSA per minute
(4) systemic vascular resistance > 2,100 dynes per second per cm^5
(5) left and/or right atrial pressure > 20 mm Hg
(6) urine output < 20 mL per hour despite optimal inotropic and vasodilating drug support
Parameters:
(1) left atrial pressure
(2) right atrial pressure
(3) cardiac arrhythmias
(4) pulmonary vascular resistance
(5) left ventricular function
(6) right ventricular function
|
Feature |
Right Ventricular Failure |
Left Ventricular Failure |
Biventricular Failure |
|
left atrial pressure |
< 15 mm Hg |
> 20 mm Hg |
> 20 mm Hg |
|
right atrial pressure |
> 20 mm Hg |
< 15 mm Hg |
> 20 mm Hg |
|
cardiac arrhythmias |
none or few |
none or few |
ventricular tachycardia or fibrillation |
|
pulmonary vascular resistance |
NA |
near normal |
NA |
|
left ventricular function |
near normal |
impaired |
severely impaired |
|
right ventricular function |
impaired |
near normal |
severely impaired |
where:
• For cardiac arrhythmias may be a gap in the spectrum between none/few and ventricular arrhythmias.
• The significance of an abnormal pulmonary vascular resistance is not listed.
• Ventricular function can be assessed using echocardiography, cardiac catheterization or MUGA scanning.
|
Pattern of Failure |
Support Device(s) |
|
right ventricular failure |
right ventricular assist device and intra-aortic balloon pump |
|
left ventricular failure |
left ventricular assist device |
|
biventricular failure |
biventricular assist device |
Specialty: Critical Care, Emergency Medicine, Cardiology
ICD-10: ,
