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



(1) left atrial pressure

(2) right atrial pressure

(3) cardiac arrhythmias

(4) pulmonary vascular resistance

(5) left ventricular function

(6) right ventricular function


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


near normal


left ventricular function

near normal


severely impaired

right ventricular function


near normal

severely impaired



• 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


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