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Well, if the patient is not able to be supported with the initial measures of trying to maintain blood pressure, they will quickly need support in terms of blood pressure support. And there are devices that we use on a day to day basis to try to support the shock patient. There is a device called the intraaortic balloon pump, which is basically a big balloon that’s placed in the aorta that inflates with each heartbeat and helps suck out the blood, if you will, when it’s deflated, to try to improve the cardiac output. But then when it’s inflated during the vessel, we push blood into the coronaries to help filling of the blood flow into the muscle of the heart. That helps support blood pressure, but also supports heart function. But a balloon pump is not always enough to support the shock patient. We have now newer pumps called the Impella, different sizes, different capacities.
That basically is a pump that’s placed through the artery, into the heart, and then gives a certain amount of cardiac output, 2.5 liter to 5 liter, depending on the size of the pump used. And these pumps can be put in the left ventricle to support the left heart, but they can also be put in the right ventricle to support the right heart. And some patients may need both types of support to try to keep them alive. If those agents are not successful, then sometimes we resort to what we call a left ventricular assist device, or a heart pump or a VAD that is a bridge to transplantation. But before we get that far, we tend to do an angiogram for the patient to see if they have blockages of the arteries.
