Early Mechanical Circulatory Support for Cardiogenic Shock

Abstract

Reversal of cardiogenic shock depends on its early recognition and prompt initiation of therapy. Recognition of the clinical and hemodynamic deterioration that precedes cardiogenic shock is a crucial step in its early detection. Treatment of pre-cardiogenic shock is chiefly pharmacologic with intravenous administration of pressor, inotropic, and loop diuretic agents. Failure to reverse the preshock state with pharmacotherapy entails progression to cardiogenic shock and the need for prompt mechanical circulatory support with membrane oxygenation and possibly left ventricular decompression.

Concomitant use of extracorporeal membrane oxygenation and percutaneous microaxial assist device support for cardiogenic shock

“…Although the median for Impella placement after VA-ECMO support was 1 day, recent studies have shown that left ventricular venting via pVADs before 12 hours of support is associated with reduced short-term mortality. 22 , 23 , 24 Therefore, this initial increase in afterload to the left ventricle may have limited initial myocardial recovery and resulted in additional complications that influenced mortality and eventual destination despite the majority of patients with AMI-CS receiving coronary intervention. All 4 patients who received coronary artery bypass grafting and 2 patients who received culprit-only percutaneous coronary intervention had VA-ECMO support with concomitant pVAD support before coronary intervention with no difference in survival in comparison to patients with AMI-CS who received full support after coronary intervention.…”