Short-Term Mechanical Circulatory Support Devices: Uses and Outcomes

In this review, we discuss common acute mechanical circulatory support (AMCS) devices summarizing their uses, hemodynamic effects, and outcomes as well as indications for their use in the treatment of various etiologies for cardiogenic shock (CS).

AMCS devices have demonstrated a survival benefit when used as a bridge to therapy or surgery in the setting of acute myocardial infarction (MI) and postcardiotomy cardiogenic shock (PCCS), but do not seem to improve mortality rates among COVID-19 patients. While limited data support their use in heart transplant candidates awaiting surgery, their detrimental effects when used for transcatheter aortic valve replacement (TAVR) patients are well-documented. Despite being the most commonly used device, the intra-aortic balloon pump (IABP) is being gradually replaced in recent years by devices such as extracorporeal membrane oxygenation (ECMO), Tandem Heart^®, and Impella^®, which offer greater hemodynamic support.

Acute MCS devices are an important consideration for the treatment of various etiologies of cardiac dysfunction, starting in the emergency department. Despite their implementation, mortality rates for CS remain high. As healthcare providers continue to weigh the benefits and costs of AMCS use, further research is needed on which combination of factors best reduce mortality.