Successful coronary angioplasty in two patients with cardiogenic shock using the Nimbus Hemopump support device.

When standard medical therapy is employed, cardiogenic shock is associated with an in-hospital mortality rate in excess of 75 % . Coronary angioplasty has been shown to reduce this mortality in patients following myocardial infarction,’ but the procedure can be complicated by transient myocardial ischemia induced by prolonged balloon inflation, acute vessel closure, or arrhythmias. To avoid possible decompensation during high-risk angioplasty, intra-aortic balloon counterpulsation and percutaneous cardiopulmonary bypass have been used to help support the circulation.2-5 Although these devices can provide variable degrees of circulatory support, none directly decompress the left ventricle and unload the heart throughout the cardiac cycle. A new circulatory support device, the Nimbus Hemopump (Nimbus Medical Inc., Ranch0 Cordova, Calif.), decompresses the left ventricle by withdrawing blood directly from the ventricular cavity and ejecting it into the descending aorta (Fig. 1). Flow up to 3.5 L/min is generated by an Archimedes spiral vane screw rotating at 25,000 rpm. We report two patients with cardiogenic shock who were successfully supported with the Hemopump during coronary angioplasties complicated by potentially catastrophic arrhythmias. Case No. 1. A 48-year-old man with an extensive anterolateral myocardial infraction was treated with tissue plasminogen activator, but developed progressive congestive heart failure and hypotension over the ensuing 48 hours. Despite inotropic support, the blood pressure (BP) remained 74/50 mm Hg, pulmonary capillary wedge pressure (PCWP) was 37 mm Hg, and the cardiac index (CI) was 2.3 L/min. The left femoral artery was surgically exposed and the 21F Hemopump was advanced into the left ventricle via a 12 mm Dacron graft anastomosed to the side of the vessel. With Hemopump support, BP rose to 96/61 mm Hg, PCWP fell to 11 mm Hg, and CI increased to 3.9 L/min.