DESIGN AND DEVELOPMENT OF MINIATURE SLOTTED IMPELLER FOR SAI SPANDAN TOTAL ARTIFICIAL HEART FOR DESTINATION THERAPY

In recent years, the use of rotary blood pumps (RBPs) as continuous ow VADs has surged ahead, and virtually eliminated the use of pulsatile-ow or volume-displacement pumps for implantable, chronic mechanical circulatory support (MCS). Circuit Design modications like that in Saispandan has imparted pulsatility into RBP.Impeller designs are a signicant factor when designing centrifugal pumps as mechanical circulatory assist devices as smaller diameter impellers with higher rotational speeds to achieve target outputs would cause more blood component trauma compared to larger diameter impellers.Hydraulic performance and hemolysis tests in the same pump housing with different prototypes is needed. Ventricular assist parameters for efcient circulatory support would include an output of 5 L/min against 100 mmHg at speeds of 2500-3500 rpm. Vein height does not contribute signicantly to evaluation metric in most studies.

P1710Risk of Mortality associated with use of mechanical support devices among comatose cardiac arrest patients

Background The impact of mechanical circulatory assist devices (MCS) has not been well studied in cardiac arrest survivors. We examined that association of MCS with risk of mortality among comatose cardiac arrest survivors Purpose Compare the survival between different MCS and non MCS groups Methods This is a retrospective cohort study of 1417 comatose adult cardiac arrest survivors that survived for at least 1 day post cardiopulmonary resuscitation. Cox proportional hazard models adjusted for demographics, resuscitation parameters, comorbidities and medications were used to compute hazard ratios for extracorporeal membrane oxygenation (ECMO), ECMO + Impella/intraaortic balloon pump (IABP), IABP and Impella associated with risk of short term 60 day mortality. Kaplan meier's curves were used to demonstrate cumulative survival rate. Results Among 1417 cardiac arrest survivors, MCS was used among 553 (39.1%) patients. After 60 days of follow up, mortality rate was 49.4% in non MCS group, 58.6% in IABP group, 22.9% in Impella group, 40.0% in ECMO only group, 50.0% in ECMO + Impella/IABP group. When compared with no MCS use, only Impella use was associated with decrease risk of short term mortality (HR 0.37; 95% CI 0.16–0.83, p=0.02) while there was no significant association of other forms of MCS with short term mortality. There was no significant association of any MCS with long term mortality. Kaplan-Meier curves demonstrate early benefit of Impella and very early benefit of ECMO (figure 1). Conclusions This is the first large study to report various types of MCS use among comatose cardiac arrest survivors and has shown an indication of benefit with Impella use only in first 60 days post cardiac arrest. Future prospective study may be needed to validate this association Acknowledgement/Funding None

Mechanical Circulatory Assist Devices

Mechanical circulatory assist devices (MCADs) are used in patients with decompensated heart failure refractory to medical therapy. The devices are used as a bridge to transplant, as a bridge to recovery for reversible conditions, as a bridge to decision while a patient’s eligibility for transplant is determined, and as destination therapy to support left-sided heart function when a patient is not eligible for transplant. MCADs restore tissue circulation by increasing blood flow and, thereby, improving organ function.

Dispositivos de asistencia mecánica circulatoria

Un dispositivo de asistencia mecánica circulatoria o AMC, es una bomba con capacidad de dar soporte mecánico a un corazón en fallo cardiaco, facilitando el bombeo de la sangre desde las cavidades cardiacas hacia la circulación sistémica. Consideramos asistencia circulatoria a cualquier dispositivo o sistema utilizado para apoyar o sustituir la función cardiaca de forma temporal o, más raramente, permanente. Por norma general nos referimos a las asistencias ventriculares mecánicas y al corazón artificial total. ABSTRACT A mechanical circulatory assist devices (MCADs) , is a pump capable of giving mechanical support to a heart in heart failure, facilitating the pumping of blood from the cardiac cavities to the systemic circulation. We consider circulatory assistance to any device or system used to support or replace cardiac function temporarily or, more rarely, permanently. As a general rule, we refer to mechanical ventricular assist and total artificial heart.

Extracorporeal Membrane Oxygenation

Extracorporeal membrane oxygenation (ECMO), also known as extracorporeal life support, is the practice of using circulatory assist devices and a gas exchange system to maintain sufficient tissue oxygen delivery, supplementing pulmonary and/or cardiac function in patients whose native physiology is too severely altered to be successfully supported solely by conventional life support techniques (eg, mechanical ventilation and inotropic and vasopressor drugs). ECMO should be considered in patients who are at a high risk of death due to a potentially reversible etiology of cardiopulmonary collapse. Indications for ECMO can be broadly divided into profound respiratory failure and/or cardiogenic shock. The indications include acute respiratory distress syndrome, heart failure, postoperative cardiogenic shock, and as an adjunct to cardiopulmonary resuscitation in patients with cardiac arrest. ECMO is currently experiencing a renaissance, and familiarity with its concepts is important for all critical care practitioners. This review contains 8 figures, 8 tables and 34 references Key Words: complications, equipment, indications, management basics, outcomes