Management of Temporary Mechanical Circulatory Support

Despite many advances in medical technology and care, cardiogenic shock (CS) mortality remains high. Use of temporary mechanical circulatory support (tMCS) devices is based on single-center experiences and small randomized trials. The choice of tMCS device depends on available resources, regional expertise, and the decision made by a multidisciplinary team regarding escalation or de-escalation of the devices. Cardiogenic shock is a syndrome characterized by end-organ hypoperfusion secondary to cardiac dysfunction that results in low cardiac output and hypotension. The presentation of CS is heterogeneous and depends on etiology, severity of illness, and comorbidities. Given the poor outcomes associated with CS, the use of tMCS devices has increased in recent years. If the process of weaning from tMCS is not successful, the American Heart Association recommends starting simultaneous evaluation for advanced heart failure therapies, including durable mechanical circulatory support (MCS) or heart transplant, as well as to involve palliative care during the entire process. If the center does not have a durable MCS or a heart transplant program, transfer to a center with these services should be considered.