Mechanical cardiac assistance

A prospective pilot study evaluating the 'cardiac decompensation score' in the setting of intraaortic balloon counterpulsation

The study objective was to determine whether the 'cardiac decompensation score' could identify cardiac decompensation in a patient with existing cardiac compromise managed with intraaortic balloon counterpulsation (IABP). A one-group, posttest-only design was utilised to collect observations in 2003 from IABP recipients treated in the intensive care unit of a 450 bed Australian, government funded, public, cardiothoracic, tertiary referral hospital. Twenty-three consecutive IABP recipients were enrolled, four of whom died in ICU (17.4%). All non-survivors exhibited primarily rising scores over the observation period (p<0.001) and had final scores of 25 or higher. In contrast, the maximum score obtained by a survivor at any time was 15. Regardless of survival, scores for the 23 participants were generally decreasing immediately following therapy escalation (p=0.016). Further reflecting these changes in patient support, there was also a trend for scores to move from rising to falling at such treatment escalations (p=0.024). This pilot study indicates the 'cardiac decompensation score' to accurately represent changes in heart function specific to an individual patient. Use of the score in conjunction with IABP may lead to earlier identification of changes occurring in a patient's cardiac function and thus facilitate improved IABP outcomes.

The intra-aortic balloon pump in heart failure management: implications for nursing practice

Management of acute heart failure is an important consideration in critical care. Mechanical support of the failing heart is crucial for improving health outcomes. The most common Australasian application of intra-aortic balloon counterpulsation (IABP) is in the setting of cardiogenic shock. High end users of IABP (>37/annum) demonstrate significantly lower mortality for cardiogenic shock managed with IABP (p<0.001) in contrast to hospitals which employ limited IABP (<4/annum). This underscores the importance of proficiency in managing the patient receiving IABP support. Nurses play a crucial role in caring for patients with acute heart failure. This paper summarises care considerations for management of the IABP.

Mechanical support availability in pediatric cardiac surgery: program size should not matter

Intractable heart failure may require Extracorporeal Life Support (ECLS) techniques for rescue therapy. Nevertheless, in many small to middle-sized centers in Europe, this valuable resource is not available. In our University pediatric intensive care unit 0.9% of 1360 open-heart surgical patients required mechanical assistance over the latest 9 years with a survival rate of 69.2% and low residual morbidity. This favorable overall outcome suggests that regardless of the program size, it is possible to ensure the availability of efficient mechanical assistance that appears to be fundamental in a center performing surgery for complex congenital or acquired cardiac diseases.