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Ann Thorac Surg 1991;52:506-513
© 1991 The Society of Thoracic Surgeons

Articles

Treatment of cardiogenic shock with the hemopump left ventricular assist device

Richard K. Wampler, MD*,a,b,c,d,e,f,g,1, O.Howard Frazier, MDa,b,c,d,e,f,g, Allan M. Lansing, MD, PhDa,b,c,d,e,f,g, Richard W. Smalling, MD, PhDa,b,c,d,e,f,g, John M. Nicklas, MDa,b,c,d,e,f,g, Steven J. Phillips, MDa,b,c,d,e,f,g, Robert A. Guyton, MDa,b,c,d,e,f,g, Leonard A.R. Golding, MDa,b,c,d,e,f,g

a Nimbus, Inc, Rancho Cordova, California, USA
b Texas Heart Institute and Hermann Hospital, Houston, Texas, USA
c Humana Hospital Audubon, Louisville, Kentucky, USA
d The University of Michigan Medical Center, Ann Arbor, Michigan, USA
e Mercy Hospital Medical Center, Des Moines, Iowa, USA
f Emory University and Crawford Long Hospitals, Atlanta, Georgia, USA
g The Cleveland Clinic Foundation, Cleveland, Ohio, USA

Accepted for publication April 29, 1991.

* Address reprint requests to Dr Wampler, Johnson and Johnson Interventional Systems, 2890 Kilgore Rd, Rancho Cordova, CA 95670.

A multiinstitutional study is in progress to evaluate the Hemopump in the treatment of cardiogenic shock. Fifty-three patients with refractory cardiogenic shock were selected for Hemopump assistance. The hemodynamic definition of cardiogenic shock included (1) a cardiac index of less than 2.0 L · min–1 · m–2, (2) pulmonary capillary wedge pressure of greater than 18 mm Hg, and (3) a systolic blood pressure of less than 90 mm Hg or a left ventricular work index of less than 1,500 g-m · m–2 · min–1. The Hemopump was successfully inserted in 41 of 53 patients (77.3%). A significant improvement in the hemodynamic status was seen during Hemopump assistance. A minimal level of hemolysis was observed. No leg ischemia was observed. The 30-day overall survival of the Hemopump group was 31.7%. Criteria establishing indications for use and clinical utility are proposed. We conclude that the Hemopump provides significant hemodynamic support of the patient in cardiogenic shock allowing for recovery from ventricular stunning in marginal ventricles, and that in select patients the Hemopump may offer a major improvement in survival over conventional therapy.




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