Intensive Care Network Podcasts

Use of Ventricular Assist Devices (VAD) and heart transplantation (HT) for end stage cardiac failure have increased significantly in recent decades. These support strategies hold inherently different risks in the face on non-cardiac critical illness, and require multidisciplinary team management.   According to INTERMACS, more than 2500 VADs/year are implanted the USA. Most implanted devices are continuous flow left-VADs (75%) which deliver systemic cardiac output directly related to pump speed and inversely related to pressure gradient across the pump. Improved survivorship has resulted in increasing outpatient management, however 12-month mortality is 12%, and 1/4 of patients within 1-year post-transplant. Systemic illnesses may also be associated with chronic immunosuppression, for example malignancy and unusual presentations of infectious disease; as well as medication toxicity where the post-transplant medication cocktail exacerbates underlying renal insufficiency and multi-organ dysfunction. Therapeutic