Percutaneous mechanical circulatory support for the anesthesiologist: indications, management, and basic physiological principles.

Abstract

in advanced stages of heart failure or cardiogenic shock (CS) Since the 1960s, the primary form of mechanical support has been the intra-aortic balloon pump (IABP). As technology has advanced, smaller, more minimally invasive devices for ventricular support have been developed. In fact, the use of temporary mechanical circulatory support (MCS) has grown more than 30-fold since 2007. 1 Some MCS devices require surgical insertion, but the area of largest growth is in devices that can be placed percutaneously for rapid stabilization of hemodynamics. Increased utilization of MCS will require anesthesiologists to be familiar with the commonly used devices and basic principles of management. General anesthesiologists may be asked to support patients during elective high-risk electrophysiology procedures or emergent noncardiac Anesthesiologists with certi fi cation in echocardiography may be asked to assist in image guidance for insertion of these devices, and anesthesia intensivists may help care for these patients during their potentially lengthy stays in the intensive care unit (ICU). This paper seeks to provide a basic understanding of the indications, management, and basic physiological principles of percutaneous MCS (pMCS) devices as well as speci fi c considerations for the anesthesiologist.