Specialist commentator comments

Comments on this technology were invited from clinical experts working in the field and relevant patient organisations. The comments received are individual opinions and do not represent NICE's view.

Three specialist commentators currently use CentriMag or PediVAS regularly. Two others are familiar with the technology but have not used it.

Level of innovation

The specialist commentators felt that the basic principle of CentriMag is well established in other devices, but most said that the device represents a significant variant; 1 stated that this is the only magnetically levitated temporary centrifugal blood pump available. All of the commentators agreed that special training is needed to use CentriMag.

Potential patient impact

Three specialist commentators stated that patients with the potential for myocardial recovery are likely to benefit from CentriMag, particularly after myocardial infarction or for people with acute cardiomyopathy. One specialist commentator stated that CentriMag may also benefit people whose cardiac function has been reduced to a life-threatening extent. One specialist commentator felt that there is currently limited high quality evidence to support a clear patient benefit and that CentriMag should be introduced only as part of research exploring the clinical and cost benefits.

CentriMag may help to stabilise patients before a heart transplant. Two specialist commentators noted that some patients would not have survived without CentriMag. One specialist commentator felt that CentriMag may reduce the number of repeat procedures needed for patients by being a bridge between short- and long‑term devices.

Potential system impact

The specialist commentators noted that using CentriMag needs a highly skilled and specialised team in an intensive care environment, and that more intensive care beds would be needed. Increased patient survival could lead to a rise in inpatient stay, increased outpatient visits, and an increased demand for donor organs and medications.

Three of the commentators expressed concerns about the use of CentriMag outside existing cardiac transplant and ECMO centres. One noted the significant training needed, and that the complexity of managing these patients means that they should only be treated in specialist centres familiar with extracorporeal support. The commentators felt that there should be a mandatory registry for patients using CentriMag in order to capture data on patient outcomes. Another commentator noted that the staff resources and facilities needed to use CentriMag were only possible at designated transplant centres. A third commentator stated that special training is needed to use CentriMag and that the technology would need to be used regularly enough to gain expertise and maintain competence. However, 1 commentator disagreed, saying that in the UK there is a need for non-transplant cardiothoracic surgical units to provide short‑term haemodynamic support before transfer to a transplant centre. This would relieve pressure on the ITU resources of transplant centres, while providing support to patients with cardiogenic shock, who could recover or be suitable for transplant or longer‑term support. Another commentator added that an important use of CentriMag is in the cardiothoracic surgical unit for post-cardiotomy salvage.

One specialist commentator thought that using CentriMag could lead to cost savings for the NHS, but the others thought this was unlikely. One stated that CentriMag may be less preferable to ECMO because inserting a VAD requires cardiac surgery, whereas ECMO is relatively easy and has lower costs.

General comments

One specialist commentator stated that current medical management has a high mortality rate.

One specialist commentator was concerned that there is growing enthusiasm among clinicians to use temporary cardiac support, despite limited clinical evidence of patient benefit and substantial associated costs. They also felt that there was limited expertise in its use outside existing ECMO and transplant centres. Another felt that being able to offer temporary mechanical circulatory support should be the standard of care for any hospital providing a cardiac surgical service, either in the form of ECMO or temporary VADs, but that there is no evidence as to which approach or device is better.

One specialist commentator noted that CentriMag may allow people with cardiogenic shock after acute heart attack to recover consciousness earlier, which would allow assessments of brain function to be made.