Critical Care Time 69. Mechanical Circulatory Support Master Class with Dr. Bindu Akkanti
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Feb 9, 2026 Dr. Bindu Akkanti, Assistant Dean and Heart Failure ICU director with expertise in cardiopulmonary critical care and mechanical circulatory support. She walks through use cases for IABP, Impella and VA‑ECMO using clinical cases. Discussions cover device selection, complications, monitoring (including PA catheters), venting strategies and combined support approaches like Ecpella and LAVA.
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When To Use An Intra‑Aortic Balloon Pump
- Use an IABP for mild–moderate LV-predominant shock when RV function is preserved and CI is borderline.
- Monitor urine output, lactate, and PA catheter data closely and escalate promptly if no improvement.
Trends Beat Single MAP Readings
- Bedside trends (urine, mental status, mixed venous, cardiac index) matter more than a one-time MAP.
- Lack of end‑organ improvement after MCS means you must reassess device choice and escalate.
Prevent And Detect Limb Ischemia Early
- Inspect the limb and check Dopplers immediately and repeatedly after IABP or large arterial access.
- Remove the balloon early if ischemia develops and involve vascular surgery urgently.