Table 1 Open in new tab Available PMCS...

Device

Access

Mechanism

Level of support

Advantages

Limitations

Contraindications

Major complications

IABP

Percutaneous or surgical 7.5–8F

Counterpulsation (systolic unloading, diastolic augmentation)

0.5 L/min

Know-how
Ease of use
Small diameter for access

Modest augmentation of CO
Uses ECG or BP triggers, not optimal for VT

Moderate to severe aortic regurgitation
Aortic valve disease
Severe PAD

Limb ischaemia
Renal or gut ischaemia
Vascular injury
Stroke

TandemHeart

Percutaneous or surgical
21F inflow (transseptal)
15 or 17 F outflow

Centrifugal continuous flow pump

3.5–5.0 L/min

Complete LV support

Large cannulas, requires TS access

Severe PAD
Ventricular septal defect
Severe RV failure

Limb ischaemia
Vascular injury
Tamponade
Stroke
Vascular injury
Residual ASD
Air embolism

Impella 2.5
Impella CP
Impella 5.0

Percutaneous or surgical
Single arterial access 13F
Percutaneous or surgical
Single arterial access 14F
Surgical cutdown
Single arterial access 21F

Axial flow pump
(pumping blood from LV to aorta)

2.5 L/min
3.5 L/min
5.0 L/min

Partial LV support
Partial LV support
Complete LV support

Large arterial cannula
Large arterial cannula
Large arterial cannula

Mechanical aortic valve
Aortic stenosis
Aortic valve disease
Moderate to severe aortic regurgitation
Severe PAD
LV thrombus
Ventricular septal defect
RV failure

Limb ischaemia
Vascular injury
Perforation
Stroke
Haemolysis
Limb ischaemia
Vascular injury
Perforation
Stroke
Haemolysis
Limb ischaemia
Vascular injury
Perforation
Stroke
Haemolysis

VA ECMO

Percutaneous or surgical
17–22F venous, 15F arterial

Centrifugal continuous flow pump with oxygenator

>4.5 L/min

Highest level of LV support
Usable in RV failure

Large cannulas
Complex setup

Severe PAD
Uncontrollable coagulopathy

Limb ischaemia
Vascular injury
Pulmonary oedema
Bleeding sepsis
Thrombus
Systemic embolism

Table 1

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Available PMCS systems

Device	Access	Mechanism	Level of support	Advantages	Limitations	Contraindications	Major complications
IABP	Percutaneous or surgical 7.5–8F	Counterpulsation (systolic unloading, diastolic augmentation)	0.5 L/min	Know-how Ease of use Small diameter for access	Modest augmentation of CO Uses ECG or BP triggers, not optimal for VT	Moderate to severe aortic regurgitation Aortic valve disease Severe PAD	Limb ischaemia Renal or gut ischaemia Vascular injury Stroke
TandemHeart	Percutaneous or surgical 21F inflow (transseptal) 15 or 17 F outflow	Centrifugal continuous flow pump	3.5–5.0 L/min	Complete LV support	Large cannulas, requires TS access	Severe PAD Ventricular septal defect Severe RV failure	Limb ischaemia Vascular injury Tamponade Stroke Vascular injury Residual ASD Air embolism
Impella 2.5 Impella CP Impella 5.0	Percutaneous or surgical Single arterial access 13F Percutaneous or surgical Single arterial access 14F Surgical cutdown Single arterial access 21F	Axial flow pump (pumping blood from LV to aorta)	2.5 L/min 3.5 L/min 5.0 L/min	Partial LV support Partial LV support Complete LV support	Large arterial cannula Large arterial cannula Large arterial cannula	Mechanical aortic valve Aortic stenosis Aortic valve disease Moderate to severe aortic regurgitation Severe PAD LV thrombus Ventricular septal defect RV failure	Limb ischaemia Vascular injury Perforation Stroke Haemolysis Limb ischaemia Vascular injury Perforation Stroke Haemolysis Limb ischaemia Vascular injury Perforation Stroke Haemolysis
VA ECMO	Percutaneous or surgical 17–22F venous, 15F arterial	Centrifugal continuous flow pump with oxygenator	>4.5 L/min	Highest level of LV support Usable in RV failure	Large cannulas Complex setup	Severe PAD Uncontrollable coagulopathy	Limb ischaemia Vascular injury Pulmonary oedema Bleeding sepsis Thrombus Systemic embolism

Device	Access	Mechanism	Level of support	Advantages	Limitations	Contraindications	Major complications
IABP	Percutaneous or surgical 7.5–8F	Counterpulsation (systolic unloading, diastolic augmentation)	0.5 L/min	Know-how Ease of use Small diameter for access	Modest augmentation of CO Uses ECG or BP triggers, not optimal for VT	Moderate to severe aortic regurgitation Aortic valve disease Severe PAD	Limb ischaemia Renal or gut ischaemia Vascular injury Stroke
TandemHeart	Percutaneous or surgical 21F inflow (transseptal) 15 or 17 F outflow	Centrifugal continuous flow pump	3.5–5.0 L/min	Complete LV support	Large cannulas, requires TS access	Severe PAD Ventricular septal defect Severe RV failure	Limb ischaemia Vascular injury Tamponade Stroke Vascular injury Residual ASD Air embolism
Impella 2.5 Impella CP Impella 5.0	Percutaneous or surgical Single arterial access 13F Percutaneous or surgical Single arterial access 14F Surgical cutdown Single arterial access 21F	Axial flow pump (pumping blood from LV to aorta)	2.5 L/min 3.5 L/min 5.0 L/min	Partial LV support Partial LV support Complete LV support	Large arterial cannula Large arterial cannula Large arterial cannula	Mechanical aortic valve Aortic stenosis Aortic valve disease Moderate to severe aortic regurgitation Severe PAD LV thrombus Ventricular septal defect RV failure	Limb ischaemia Vascular injury Perforation Stroke Haemolysis Limb ischaemia Vascular injury Perforation Stroke Haemolysis Limb ischaemia Vascular injury Perforation Stroke Haemolysis
VA ECMO	Percutaneous or surgical 17–22F venous, 15F arterial	Centrifugal continuous flow pump with oxygenator	>4.5 L/min	Highest level of LV support Usable in RV failure	Large cannulas Complex setup	Severe PAD Uncontrollable coagulopathy	Limb ischaemia Vascular injury Pulmonary oedema Bleeding sepsis Thrombus Systemic embolism

ASD, atrial septal defect; BP, blood pressure; CO, cardiac output; IABP, intra-aortic balloon pump; LV, left ventricular; PAD, peripheral artery disease; PMCS, percutaneous mechanical cardiac support; RV, right ventricular; VA ECMO, venoarterial extracorporeal membrane oxygenation; VT, ventricular tachycardia.

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