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Lynchburg Journal of Medical Science

Lynchburg Journal of Medical Science

Specialty

Cardiology, Palliative Care Medicine

Advisor

Dr. Mark Archambault

Abstract

Purpose: Inform Advanced Practice Practitioners (APP’s) regarding the various types of Mechanical Circulatory Support (MCS) Devices and usage in End-Stage Heart Failure (ESHF) and the role of the Palliative Care (PC) team, if any. When should palliative care be involved in this patient population? Review how Palliative Care plays a role in this patient population during the decision-making process and discussions. Should the Palliative Care Team be consulted in patients with End-Stage Heart before the implantation or insertion of an MCS device as a form of treatment modality? In what stage of the decision-making process should they be involved? A brief overview on Bridge to Transplant (BTT), Bridge to Candidacy (BTC), and Destination Therapy (DT).

Method: Several search engines were conducted as part of the literature search. Using keywords such as Mechanical Circulatory Support Device (MCS), Extracorporeal Membrane Oxygenation (ECMO), Left Ventricular Assist Device (LVAD), AbioMed, Heartmate, and Heart Ware devices, and Palliative Care. To complete this manuscript, more than 20 articles were containing the listed keywords were reviewed. 9 articles were retrieved, serving as a guiding tool and reference for this clinical review.

Results: Most of the data was outdated regarding the various MCS types and usage. Not enough data and research information were readily available to answer the key questions of PC role during MCS insertion.

Conclusion: Depending on the institution, the MCS team and The PC team will work cohesively to benefit the patient. Depending on the device, they are not consulted at the early stages. In serious illness discussions, the PC team should be part of the discussion at the onset. Most institutions will collaborate with the PC team mostly during left ventricular assist device (L-VAD) implants. Unfortunately, the PC team's involvement is used at later stages when care (GOC) decisions are being made. There is an increased level of frustration between family members, patients, caregivers, and care providers during that stage. This adds further stressors on the patient with a failing heart.

Keywords: Mechanical Circulatory Support Device (MCS), Extracorporeal Membrane Oxygenation (ECMO), Left Ventricular Assist Device (LVAD), AbioMed, Heartmate, Heart Ware devices, and Palliative Care

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