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Selecting Children for Mechanical Circulatory Support 

Selecting Children for Mechanical Circulatory Support
Chapter:
Selecting Children for Mechanical Circulatory Support
Author(s):

Devon O. Aganga

, Charlotte S. Van Dorn

, and Jonathan N. Johnson

DOI:
10.1093/med/9780190909291.003.0009
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date: 28 May 2020

Mechanical circulatory support (MCS) has become a critical tool for managing children with impending respiratory and cardiac failure. Although extracorporeal membrane oxygenation was classically the only form of support available for children, ventricular assist devices (VADs) are increasingly used in children. Common indications for MCS include an inability to oxygenate or ventilate that progresses to respiratory failure and cardiac failure secondary to anatomic abnormalities or primary myocardial failure. The most common contraindication for MCS is death in the near future. This contraindication may include patients with other fatal systemic diseases, patients at high risk of bleeding, or extreme prematurity. Important recent advances in VAD technology include the introduction of the Berlin Heart EXCOR device, as well as the successful use of devices for adults (e.g., the Heartmate and Heartware VADs) in larger children. Although outcomes of VAD support in children have been promising, further studies of smaller and clinically more complex children are required.

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