Temporary ventricular assist devices in the intensive care unit as a bridge to decision.

Morbidity and mortality in patients with cardiogenic shock remain high despite the recent advances in therapy. New temporary ventricular assist devices (VADs) that are rapidly applied to normalize cardiac output in patients with severe heart failure are being used more frequently. Bridge to decision describes the temporary use of a VAD to stabilize critically ill patients until complete diagnostic tests are performed and decisions about more definitive therapy are made. The CentriMag, TandemHeart, and Impella VADs offer versatility for use in many patients and in multiple hospital settings. These VADs provide continuous blood flow, altering the usual assessment of arterial blood pressure. Patients are usually immobilized during support to prevent dislodgement of cannulas. Anticoagulation therapy is commonly required, and bleeding is a frequent complication. Infection prevention measures must be used to avoid septic complications. In the past 10 years, clinical experience with these devices has expanded, but they remain underused.