Support of the Failing Circulation: The Use of a Pump Oxygenator in Clinical Cardiac Failure.

Mechanical assistance to the failing circulation is a controversial subject, with a number of unanswered physical, biological, and philosophic questions. The author of this monograph gives the reader the benefit of 2½ years of personal experience with experimental and clinical observations of the effects of the circulatory bypass techniques and their applications. He defines the physiological problem of the failing circulation clearly and provides detailed observations on 13 patients undergoing either open-chest (left atrioarterial) or peripheral (venoarterial with oxygenation) bypass. Six of these patients were undergoing cardiac surgery and required support either prior to definitive surgery or intraoperatively, because of severe failure. The remaining seven were "medical" patients with a variety of essentially inoperable conditions. His chapter on selection of patients outlines the important factors. He also describes his method of bedside hemodynamic appraisal of the patient with failing circulation and makes the point that intervention at the right time