Heart failure clinics
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Heart failure clinics · Jan 2014
ReviewExtracorporeal membrane oxygenation for resuscitation and cardiac arrest management.
This article reviews the potential application of extracorporeal membrane oxygenation (ECMO) technology to cardiopulmonary resuscitation for in and out-of-hospital cardiac arrest and discusses the current evidence on the subject. The possible strategies for organ protection during ECMO and the concept of ECMO networks are also reviewed.
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The essence of a Fontan circuit is the creation of the Fontan "neoportal system," which allows for oxygenation at near normal levels, but at the cost of a chronic state of systemic venous congestion and decreased cardiac output. The heart, while still the engine of the circuit, cannot compensate for this major flow restriction: the ventricle has lost control of the output and venous congestion. ⋯ The abnormal hemodynamics affects organs outside the heart and may lead to liver cirrhosis/malignancy, protein-losing enteropathy, or plastic bronchitis. The chronic low flow state causes an increase of pulmonary (and systemic) vascular resistance and ventricular filling pressures, causing failure of the Fontan to be progressive with increasing functional impairment.
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Heart failure clinics · Jan 2014
Review Historical ArticleA history of devices as an alternative to heart transplantation.
The rapid evolution of mechanical circulatory support (MCS) has extended survival and improved quality of life for patients suffering from the most advanced heart failure (HF). Survival at one year after placement of a left ventricular assist device exceeds 80%. ⋯ Patients with HF now have a meaningful option for lifelong support even if they are not candidates for heart transplant. As the profiles of MCS recipients change and the next generation of devices emerges, new challenges and opportunities await physicians caring for patients with cardiac failure.