Indications and Efficacy of Ventricular Support Devices: LVADs and ECMO Michael S Firstenberg, MD FACC Assistant Professor of Surgery Northeast Ohio Medical University Cardiothoracic Surgery Akron City Hospital - The Summa Health System None Discussing non-FDA approved topics Case 2: 40 year/old, sudden death 40 year/old, otherwise health •Playing basketball (with Pastor, no less) •Sudden death – shock with AED x2 •Intubated at hospital •DES to acutely occluded LAD •IABP placed, stabilized Transferred on Neo drip Lido/Amio/Lopressor Reported: Awake/Alert/MAE Evaluation for emergent LVAD?? Upon arrival: Vitals: HR 117; BP: 153/69 Vent: 100% O2, ACVC+, TV: 550 PEEP=15, PIP=35,Flolan/Nitric ABG: pH=7.41, PCO2=39, PO2=33, HCO3=24, BE=-0.3, SaO2=65% Cardiogenic shock? Something doesn’t make sense? Now what? ECMO: A Dark History Letter Word? • Historically – Cardiothoracic ICU – Neonatal ICU • Complex Technology • Poor Outcomes • Difficult management BUT:  Evolving technology  Better understanding of physiology  Clearer indications/contraindications  Better patient care and management Reality: Now, Not As Bad As It Sounds Axillary Artery Cannulation Femoral Vein Cannulation Beer?  Oliguria  < 0.5 mL/kg/hr  Cardiac index  < 2.2 L/min/m2  Stroke volume index  < 25 mL/beat/m2   Filling pressures  SBP < 90 mmHg or MAP < 65 mmHg  Metabolic/Lactic acidosis  Multi-organ dysfunction – renal/neuro Inadequate cardiac function to support “normal” tissue function AMI: Temporal Trends in Shock: Improvements? 16 Shock, overall (p=0.001) 14 Shock developing during hospital (p