ABC | Volume 111, Nº1, July 2018

Special Article Ayub-Ferreira Guidelines for MCS of the BSC Arq Bras Cardiol. 2018; 111(1):4-12 Chart 5 – Temporary mechanical circulatory support devices available in Brazil Characteristics Intra-aortic balloon ECMO TandemHeart™ Impella 2.5® Impella CP® Impella 5.0® CentriMag® EXCOR® Mechanism Pneumatic Centrifugal Centrifugal Axial Centrifugal Pulsatile Access Percutaneous Percutaneous / thoracotomy Percutaneous Percutaneous Percutaneous Dissection Thoracotomy Thoracotomy Cannulation 7-9 F 18-21 F Inflow 15-22 F Outflow 21 F Inflow 15-17 F Outflow 12 F 14 F 21 F 24-34 F 27-48 F Inflow 36-48 F Outflow Insertion technique Descending aorta via femoral artery Percutaneous: - Inflow: right atrium via femoral or jugular vein - Outflow: descending aorta via femoral artery Thoracotomy: - Inflow: right atrium - Outflow: pulmonary artery (left mechanical circulatory assist device) or ascending aorta (biventricular assist device) Inflow: left atrium via femoral vein and transseptal puncture Outflow: femoral artery Insertion into left ventricle via femoral artery ACM-E: - Inflow: left ventricle (via left atrium or apex of left ventricle) - Outflow: ascending aorta ACM-D: - Inflow: right atrium - Outflow: pulmonary artery ACM-E: - Inflow: left ventricle (apex of left ventricle) - Outflow: ascending aorta ACM-D: - Inflow: right atrium - Outflow: pulmonary artery Hemodynamic support 0.5 L/min > 4.5 L/min 4 L/min 2.5 L/min 3.7 L/min 5.0 L/min Up to 8-10 L/min Up to 8 L/min ECMO: Extracorporeal membrane oxygenation Recommendations for intra-aortic balloon pump implantation Recommendation Class Evidence level Post-AMI cardiogenic shock IIa B Post-AMI mechanical complication with cardiogenic shock IIa C Refractory angina after standard therapy for acute coronary syndrome IIa C Cardiogenic shock in ischemic / non‑ischemic chronic cardiomyopathy IIa C Intervention support for patients at high cardiac risk IIb C AMI: acute myocardial infarction Although IABP is still used in the clinical practice especially in younger patients with less severe cardiogenic shock, the efficacy of the method should be carefully evaluated based on improvement of objective parameters of tissue microperfusion. Lack of improvement of these variables in a short time period (hours) justifies the selection of more invasive devices. Percutaneous circulatory devices Definition and benefits Percutaneous circulatory devices enable active support without requiring a synchronism with the cardiac cycle. The main benefits are maintenance of tissue perfusion, improvement of coronary perfusion, and reduction of myocardial oxygen consumption, filling pressures and ventricular wall stress, providing a circulatory support in cardiogenic shock. 25,26 Recommendations for percutaneous circulatory support device implantation Recommendation Class Evidence level Post-AMI cardiogenic shock IIa C Support for interventions in patients at high cardiac risk IIb C AMI: acute myocardial infarction 7