Key Points
Î Mechanical circulatory support (MCS) offers a surgical option for advanced
heart failure when optimal medical therapy is inadequate.
Î MCS therapy improves prognosis, functional status, and quality of life.
Î Ambulatory patients with MCS can span the entire age spectrum from
pediatrics to geriatrics.
Î Because patients with MCS are becoming increasingly mobile, basic
knowledge of equipment is necessary for personnel in public areas such as
schools, public transportation, and airplanes/airports.
Diagnosis
Patient Evaluation
Î The primary MCS team should be contacted for any patient-related
emergencies.
Î In non–life-threatening situations, care providers inexperienced with the
management of MCS should defer device management to patients and their
family caregivers until contact can be established with the MCS center or
device company technical support.
Î Whenever possible, emergency medical service providers who will be
transporting a patients on MCS should also transport the patient's backup
and peripheral equipment.
Î A Doppler probe and a manual cuff can be used to obtain blood pressure
in a patient supported by continuous-flow MCS because the automated
measurement of heart rate, pulse oximetry, and blood pressure may be
unreliable in this setting.
Î Once pump function is established, assessment of the unstable patient on
MCS should begin with a general evaluation of the patient for the inciting
condition (e.g., arrhythmia, hypovolemic or distributive shock, and acute
blood loss).
Î Outpatients who present with MCS device stoppage should not have the
device restarted without the guidance of the primary MCS center.
