Mechanical circulatory assist devices in critical care management

Two principles govern the appropriate utilization of mechanical circulatory support (MCS). First, the choice of a device is a compromise between invasiveness and desired functional improvement. Second, the major goals of MCS are: a) to rest the myocardium; b) to maintain vital organ perfusion; and c) to support the patient to myocardial recovery or replacement. Specific criteria for device implantation exist but must be modified to reflect the comorbidities of the patient and the center-specific experience to enable timely institution of MCS, The postoperative care of mechanically assisted patients is also critical to the success of an RIGS program and has driven MCS teams to research and to learn new innovative ways of treating a variety of physiologic pathologies in the critical care arena. These lessons have improved care for all ICU patients. Placement of a device is only the beginning of a multidisciplinary therapy which requires a well-organized and specialized team to care for and to learn from these patients, MCS has added a new and higher level of support that the surgeon and intensivist can offer patients who previously had little hope. The timely implementation of these devices coupled with their improving: technology and increasing reliability, has begun to change the perception of MCS from a desperate measure to an effective therapeutic option that should be understood and utilized by those clinicians who manage the care of the critically ill.