Article Figures & Data
Figures
- FIGURE 1
In one configuration of venoarterial extracorporeal membrane oxygenation (ECMO), blood is removed from the inferior vena cava, a centrifugal pump passes it over a membrane oxygenator, and it is ejected into the aorta.
- FIGURE 2
An intra-aortic balloon pump (lABP) deflates at the beginning of systole (left) and inflates at the beginning of diastole (right), increasing coronary perfusion and reducing left ventricular afterload.
- FIGURE 3
The Impella device withdraws blood from the left ventricle and ejects it into the ascending aorta.
- FIGURE 4
The TandemHeart intake catheter is inserted through the venous circulation and across the atrial septum into the left atrium.
- FIGURE 5
The Impella RP removes blood from the inferior vena cava and ejects it into the pulmonary artery.
Tables
Centers for Medicare and Medicaid Services Criteria New York Heart Association class IV (severe limitations) Intra-aortic balloon pump (> 7 days) (or peak VO2 < 14 mL/kg/min) No response to medical therapy Left ventricular ejection fraction < 25% Adequate right ventricular function Major contraindications to heart transplant Smoking cessation < 6 months Substance dependency Inadequate decision-making capacity Irreversible pulmonary hypertension (> 5 Wood units) Psychosocial issues Other end-organ issues IABP TandemHeart Impella 2.5 Impella CP, 5.0 ECMO CentriMag Circulatory support 15% 30%–60% 30%–60% 75%–100% 75%–100% 75%–100% Insertion Percutaneous Percutaneous, septal puncture Percutaneous Arterial access Percutaneous Sternotomy ECMO = extracorporeal membrane oxygenation; IABP = intra-aortic balloon pump
ECMO Rotaflow CentriMag Ventricular Assist System Impella RP Cannulation inflow Pulmonary artery Pulmonary artery Single cannula Cannulation outflow Femoral vein, right atrium Femoral vein, right atrium Single cannula Ease of insertion Easy Easy More difficult Insertion Sternotomy Sternotomy Percutaneous Cost $ $$ $$$ Biocompatibility Compatible Very compatible Compatible
