Summarising strategy, physiological effects and disadvantages of IABP, Impella, TandemHeart and VA-ECMO
| Device | Mechanism | Proposed physiology effects | Potential advantages | Potential disadvantages |
|---|---|---|---|---|
| IABP | Phasic (pulsatile) modulation of aortic pressure by displacing aortic blood volume | Reduces LV afterload Augments aortic diastolic pressure Increases coronary flow during active ischaemia21 | Ease of insertion No need for intracardiac penetration | Contraindicated in aortic regurgitation Dependent on native contractile function Inefficient during arrhythmia or marked hypotension Modest increase in systemic perfusion and LV unloading |
| Impella recover | LV to ascending aortic continuous flow microaxial flow pump (intracorporeal) | Reduce LV pressure and volume (PVA) Augments systemic mean pressure Increases coronary flow during active ischaemia22 | Ease of insertion Independent of native contractile function | Contraindicated in presence of LV thrombus and aortic regurgitation Risk of haemolysis Bleeding complications Vascular complications |
| TandemHeart | Left atrial to descending aortic non-pulsatile flow, extracorporeal pump | Reduces LV preload thereby reducing LV volumes (PVA) Augments systemic mean pressure | Independent of native contractile function Can be used in the setting of aortic regurgitation23 | Bleeding complications Vascular complications Requires transseptal puncture Risk of haemolysis |
| VA-ECMO | Right atrial to descending aortic flow, retrograde if peripheral type Extracorporeal pump with membrane oxygenator | Augments systemic mean pressure Supplements systemic oxygenation | Independent of native contractile function Useful for biventricular failure | Bleeding complications Vascular complications No change in PVA Requires LV venting to reduce any increase in LV afterload Risk of haemolysis |
AR, aortic regurgitation; IABP, intra-aortic balloon pump; LV, left ventricular; MAP, mean arterial pressure; PVA, pressure volume area; VA-ECMO, veno-arterial extracorporeal membrane oxygenation.