Introduction:
Hemodynamic support devices are medical tools designed to help the heart pump blood more effectively, often used in cases of heart failure or during certain cardiac procedures. They can include intra-aortic balloon pumps, ventricular assist devices (VADs), and extracorporeal membrane oxygenation (ECMO). Depending on the patient's needs, these devices can provide temporary or long-term support.
What Is the Purpose of Hemodynamic Support Devices?
The primary purpose of hemodynamic support devices is to improve blood circulation and cardiac function, especially in cases of heart failure or during cardiac procedures. They can help maintain adequate blood flow to vital organs and tissues, stabilize the patient’s condition, and provide time for further treatment or recovery.
When Is a Hemodynamic Support Device Used?
Hemodynamic support devices are used in various clinical scenarios, including:
Acute Heart Failure: Acute heart failure is when the heart suddenly can not pump enough blood to meet the body’s needs. It can happen due to conditions like heart attacks, infections, or sudden changes in heart function.
Cardiogenic Shock: Cardiogenic shock occurs when the heart suddenly can not pump enough blood, leading to a severe drop in blood pressure and inadequate blood flow to organs.
Bridge to Heart Transplantation: Hemodynamic support devices can help sustain patients with severe heart failure while they await heart.
High-Risk Cardiac Procedures: During high-risk cardiac procedures, like coronary artery bypass grafting (CABG) or valve replacement surgery. Bridge to recovery for patients awaiting myocardial recovery.
Interim Usage: This is a temporary measure to stabilize patients before definitive treatment or recovery.
Can Hemodynamic Support Devices Used by Everyone?
Hemodynamic support devices may not be suitable for use in certain situations, such as:
Severe Infection: Infections can increase the risk of complications associated with implantation and usage of these devices.
Bleeding Disorders: Conditions that affect the body’s ability to clot blood may increase the risk of bleeding complications during device implantation or usage.
Severe Anatomical Abnormalities: Anomalies in the heart or blood vessels may pose challenges to device placement or function.
End-stage Organ Failure: In some cases of advanced organ failure, the associated risks with device implantation and management may hinder the potential benefits.
How Do Hemodynamic Support Devices Work?
Hemodynamic support devices work in various ways depending on the specific device, but their main goal is to assist the heart in pumping blood effectively. For example:
Pacemakers: These are used to regulate heart rhythm by sending electrical impulses to the heart muscle.
Implantable Cardioverter Defibrillators (ICDs): Monitor heart rhythm and deliver electrical shocks to restore normal rhythm in case of dangerous arrhythmias.
Intra-Aortic Balloon Pump (IABP): It uses a balloon inserted into the aorta to help the heart pump blood by inflating and deflating in sync with the rhythm of the heart, which improves coronary artery blood flow and reducing the workload of the heart.
Ventricular Assist Devices (VADS): These devices are implanted to assist one or both ventricles of the heart in pumping blood. They can be temporary or permanent. This helps in maintaining the to and fro blood flow.
Impella - It is a temporary VAD that is often utilized in cases of acute myocardial infarction (sudden chest pain due to a decrease in blood flow to the heart), cardiogenic shock, or as a support during high-risk percutaneous coronary interventions or cardiac surgeries.
Extracorporeal Membrane Oxygenation(ECMO): ECMO temporarily takes over the function of the heart and lungs by removing blood from the body, converting deoxygenated blood into oxygenated blood, and then returning it to the body, providing temporary support for patients with severe heart or lung failure.
Tandem Heart: The TandemHeart is a temporary circulatory support device used in critically ill patients with severe heart failure or during high-risk cardiac procedures. It provides hemodynamic support by diverting blood from the left atrium or left ventricle to the femoral artery, thereby augmenting cardiac output and reducing the workload on the heart. It is typically used in patients who are not responding to conventional treatments or who require additional support during procedures like high-risk percutaneous coronary interventions or cardiac surgeries.
What Are the Signs Hemodynamic Support Devices Monitor?
Hemodynamic support devices typically monitor various vital signs and parameters related to heart function and blood circulation. These may include:
Heart Rate: Monitoring the heart’s rhythm and rate to ensure it is within a normal range.
Blood Pressure: Continuously monitoring blood pressure to detect any fluctuations or abnormalities.
Cardiac Output: Measuring the volume of blood pumped by the heart per minute, which is crucial for assessing cardiac function.
Pulmonary Artery Pressure: Monitoring pressure in the pulmonary artery to assess heart and lung function.
Central Venous Pressure: Measuring pressure in the large veins near the heart to evaluate the fluid status and cardiac function.
What One Should Be Vigilant When With Implantable Hemodynamic Support Devices?
When using an implantable hemodynamic support device, it is essential to monitor for signs of infection around the implant site, changes in device function or power supply, and any unusual symptoms such as chest pain or shortness of breath. Regular check-ups with healthcare providers are essential to ensure proper functioning and to address any concerns promptly.
What Are the Do’s and Do Nots When Having Hemodynamic Support Devices?
Do’s:
One should follow the healthcare provider’s instructions for device care and maintenance.
Keep all scheduled follow-up appointments for device monitoring.
Notify the healthcare provider immediately on experiencing any unusual symptoms or changes in health.
Carry a medical identification card indicating the presence of the device.
Inform other healthcare providers about the presence of the device before undergoing any medical procedures or tests.
Do Not’s:
Do not ignore any symptoms or changes in health, even if they seem minor.
Do not attempt to adjust or modify the device settings.
Avoid activities or environments that may expose the device to strong electromagnetic fields without consulting the healthcare provider.
Do not skip any prescribed medications or therapies without consulting the healthcare provider.
Avoid contact sports or activities that may put excessive strain on the device.
Conclusion:
Hemodynamic support devices, ranging from implantable to external systems, play a vital role in managing heart failure and other cardiac conditions. These devices assist in maintaining adequate blood flow and cardiac function, improving patients' quality of life and survival rates. However, whether implantable or external, keen monitoring, sticking to medical advice, and timely intervention are essential for positive outcomes and minimizing complications. As technology advances, these devices continue to evolve, offering new hope and possibilities for patients with compromised cardiac function.
