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Tag Archives: circulatory support

NICE guidelines for acute heart failure: long on pills, short on pumps

April 2015 Br J Cardiol 2015;22:(2) doi:10.5837/bjc.2015.014 Online First

NICE guidelines for acute heart failure: long on pills, short on pumps

Stephen Westaby

Abstract

Professor Stephen Westaby NICE’s medical therapy is excellent, until the end game, but drugs alone have limitations.5 Inotropes worsen ischaemia, while vasopressors elevate afterload. Injured myocardium needs rest to promote recovery, not a flogging.6 Consider two real patients. A 21-year-old female with ion-channelopathy is admitted to a tertiary care centre. After 75 DC shocks and cardiac massage she is in shock. She needs extracorporeal membrane oxygenation (ECMO) circulatory support but cannot be transferred.6 She dies. A 56-year-old male with ischaemic cardiomyopathy suffers acute on chronic heart failure. Renal impairment and pulmonar

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September 2014 Br J Cardiol 2014;21:96–7 doi:10.5837/bjc.2014.026

TAVI – assessing the need for circulatory support

Christopher J Allen, Alison M Duncan, Neil E Moat, Alistair C Lindsay

Abstract

Detailed preoperative work-up and careful patient selection with input from multi-disciplinary ‘heart teams’ (cardiac surgeons, interventional cardiologists, anaesthetists, nursing staff) are integral to good practice and to minimising the risk of what remains a complex and often challenging procedure. Serious complications (e.g. severe aortic regurgitation, major bleeding, device embolisation, coronary occlusion, and aortic dissection) are uncommon (<5%), but may precipitate sudden haemodynamic collapse necessitating cardiopulmonary bypass (CPB) or other mechanical support. Current guidelines, therefore, mandate ‘full haemodynamic c

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