Up-dates on Cardio-Circulatory Support

Abstract

In-hospital mortality rates have approved in the recent past1 6 to 12-month death persists at approximately 50%2. The goal of treatment is to reestablish tissue perfusion while closely monitoring hemodynamics. Provisional automatic cardiovascular support is a mainstay of the management of patients who cannot be stabilized with medical therapy. Apart from the acute setting, automatic cardiovascular support is also used in the mid- and long-term treatment of heart failure patients. This can either be until heart transplant or life-long in patents who are not candidates for heart transplant. Further it is an essential tool of open-heart surgery. In the present review we will give an overview and update of the different devices for mechanical cardiac support. Non-mechanical Cardio-Circulatory Support includes intravenous fluids and pharmacological treatment with vasopressors and inotropic agents. Norepinephrine is mainly a vasopressor, but also has other activities such as inotropy. It serves as first line agent, particularly in the acute setting of a cardiogenic shock. A recent randomized trial comparing Norepinephrine versus Epinephrine in cardiogenic shock after myocardial infarction found that Norepinephrine appeared to be a safer choice than Epinephrine3. Vasopressin causes less pulmonary vasoconstriction than norepinephrine and is therefore might better as a first line vasopressor compared to Norepinephrine4. Dobutamine, a beta agonist is frequently being used for cardiogenic shock, acting as inotropic agent. Levosimendan is a Calcium sensitizer and often used in patients with acute decompensation of chronic heart failure.