Mechanical Circulatory Support in the New Era: An Overview

Kiran Shekar; Shaun D. Gregory; John F. Fraser


Crit Care. 2016;20(66) 

In This Article

Quality Assurance, Governance and Benchmarking

Whilst MCS devices appear to be attractive technologies, the multidisciplinary teamwork required is substantial – and one key to success is a smooth decision-making paradigm including all the relevant players, where all the options discussed are considered, but acted upon in a timely fashion, thus delaying any further physiological deterioration of the patient. Currently, clinicians working with MCS must deal with a developing technology still with substantial risks. To optimize outcome in patients requiring MCS, clearly defined work unit guidelines and protocols are needed that can minimize the risks associated with the currently imperfect technology. The risk/benefit ratio of MCS will be improved further if the multiple stakeholders in this field collaborate in a silo free research environment – bringing together fields as disparate but inextricably linked as engineering, science, medical, surgical, intensive care and allied health. Governance, quality assurance and benchmarking of MCS practices are also essential to determine optimal team make-up and volume of cases/types of case to be undertaken in each advanced center to maintain adequate skills and knowledge base. Centers that are proficient in the full array of MCS options discussed in this chapter may serve as a 'hub' for several peripheral centers that can initiate timely temporary MCS (typically peripheral VA-ECMO). Case volume and outcome relationships are very likely to exist in such specialized areas of care and maintaining staff training and individual/institutional accreditation also needs to be considered. Similarly, patient referral patterns to these advanced MCS centers from other centers will change, creating pressure on transfer capabilities, intensive care and hospital resources. As the field evolves, data from ELSO, INTERMACS and other local and international registries will allow clinicians to audit and improve upon their clinical practice. Governance and organizational issues must be addressed at a number of levels, and this discussion will require health economists and policy makers to be involved ab initio.