Short Term Mechanical Circulatory Support: Patient and Device Selection

Registry data and randomized controlled trials have demonstrated high mortality of cardiogenic shock which unfortunately has not changed in the past several decades. The definition of cardiogenic shock is sustained hypotension with systolic blood pressure <90 mm Hg for 30 min accompanied with symptoms of decreased end organ perfusion. Mechanical circulatory support offers an opportunity to save lives but there is paucity of literature on device specific recommendations in cardiogenic shock state. There is a concept of a tailored approach to acute cardiogenic shock and the selection of mechanical circulatory support. It is alarming that despite a growing armamentarium of mechanical circulatory support devices and sophisticated skill sets, the outlook has remained grim for cardiogenic shock. A multifaceted approach including timely intervention, an individualized approach focusing on tailored device selection of mechanical circulatory support deployed by a shock team that is capable of early and efficient execution of protocols holds promise in improving mortality and making a substantial difference in existing outcomes. Clinical trials which are not only focused on the etiologic subgroups but also on the hemodynamic trajectory of the patient may very well provide the guidance needed for acute mechanical circulatory support device selection in cardiogenic shock.