Mechanical Support for Cardiac and Respiratory Failure in Pediatric Patients

In Mechanical Support for Cardiac and Respiratory Failure in Pediatric Patients, Dr. Brian W. Duncan has edited a comprehensive review of the clinical applications and latest research related to cardiovascu-lar assist devices in children. This important resource brings together expert insight and instruction from several experienced contributors and is particularly valuable as the use of cardiac assist devices becomes more common in the care of critically ill infants, children, and adolescents. Topics visited include types of devices and support and the indications for their use, physiology, techni-cal management, trouble-shooting, and nursing care. The 1st third of the text directs focus on patient care and the different modes of cardiac support. Circuits such as those provided by centrifugal pumping, intra-aortic balloon counterpulsation, and extracorporeal membrane oxygenation are described, with attention given to technical details, complications, and clinical outcomes. Additional chapters cover patient management during mechanical assistance; these highlight important features of hemodynamic monitoring, respiratory support, fluid balance, and neurologic surveillance. The 2nd third of the book explores the use of devices in several different clinical situations. A wide range of indications for use is examined, including myocarditis, cardiomyopathy, septic shock, acute respiratory distress syndrome, lung transplantation, and cardiac transplantation; in this last context, a chapter is devoted to the use of mechanical circulatory support both as a bridge to transplant and as an aide during acute allograft rejection. Of particular interest is a chapter that reviews the use of rapid-deployment extracorporeal membrane oxygenation (ECMO) for the resuscitation of children with cardiac disease following cardiac arrest. In it, the author describes his own institution's experience with prompt-response ECMO and how his group has managed patients using brief periods of mechanical support within 15 minutes of unsuccessful cardiopulmonary resusci-tation. He makes a persuasive argument that these critically ill children are salvageable and deserve an aggressive approach to resuscitation. In the remainder of the volume, several different ventricular assist devices are discussed in detail. The HeartMate device, the Medos device, the Berlin Heart, and the Nimbus/University of Pittsburgh rotary blood pump are all given thorough reviews. The final chapter deals with ventricular remodeling and thyroid regulation during mechanical circulatory assistance. As more is learned about myocardial matrix turnover and as ventricular assist devices continue to be designed for smaller patients, an expansion of this chapter may benefit future editions.