Hemodynamic predictors for weaning patients from ventricular assist devices (VADs)

In order to find hemodynamic parameters that can accurately predict whether patients can be successfully weaned from ventricular assist devices (VADs), we studied data from 17 patients supported with Pierce-Donachy VADs [11 left VAD (LVAD); 6 right VAD (RVAD)] following cardiogenic shock for periods from 1.3 to 22 days (mean 5.4). Myocardial recovery was determined by daily measurements of "pump on pump off" parameters, and the data from the 8 LVAD patients and 3 RVAD patients whose hearts recovered were compared to the data from those whose did not. In this study, daily pump on pump off hemodynamic measurements were found to be predictive of success for weaning patients from VADs. In particular, the most significant predictors were: increases in mixed venous oxygen saturation, cardiac index, mean arterial pressure and ventricular ejection fraction, as well as decreases in atrial pressures. An index for measuring hemodynamic function with the VAD off is proposed, as are models of recovery. Seventy percent of the patients weaned from VADs survived, indicating that patients appropriately weaned from VAD support have a reasonable chance for survival.