Mechanical Circulatory Support for Acute Heart Failure Complicated by Cardiogenic Shock

Abstract

Acute heart failure is a potentially life-threatening condition that can lead to cardiogenic shock, which is associated with hypotension and organ failure. Although there have been many studies on the treatment for cardiogenic shock, early mortality remains high at 40-50%. No new medicines for cardiogenic shock have been developed. Recently, there has been a gradual decline in the use of the intra-aortic balloon pump mainly due to a lack of adequate hemodynamic support. Extracorporeal membrane oxygenation and the percutaneous ventricular assist device have become more widely used in recent years. A thorough understanding of the mechanisms of such mechanical support devices and their hemodynamic effects, components of the devices, implantation technique, management, criteria for indications or contraindications of use, and clinical outcomes as well as multidisciplinary decision making may improve the outcomes in patients experiencing cardiogenic shock.

Physical Therapy for Adults with Heart Failure

“…For individuals with ADHF and cardiogenic shock (i.e., hypotension accompanied by hypoperfusion of organs), mechanical circulatory support devices are commonly used. Intra-aortic balloon pump is a device that helps reduce the afterload of the heart and increase cardiac perfusion, which has been the most widely used device since the 1960s 61) . Recently, the use of ventricular assist devices (VADs) and extracorporeal membrane oxygenation (ECMO) has dramatically increased because they provide a greater level of hemodynamic support.…”

Outcomes of left ventricular unloading with a transseptal cannula during extracorporeal membrane oxygenation in adults

“…Venoarterial (VA) extracorporeal membrane oxygenation (ECMO) is commonly used for short-term mechanical circulatory support in cardiogenic shock. 1,2 VA ECMO improves the survival rate of cardiac arrest patients 3 and can be a bridge to myocardial recovery, cardiac transplantation, or the implantation of a left ventricular (LV) assist device. 4 However, the proportion of cardiac patients who survive to discharge is still low, only reaching up to 40%.…”

Prognosis of Venoarterial Extracorporeal Membrane Oxygenation in Mixed, Cardiogenic and Septic Shock

“…Venoarterial extracorporeal membrane oxygenation is a widely accepted treatment option for temporary circulatory support in refractory CS. 10 However, applying VA-ECMO in refractory SS remains controversial. 11,12 In a recent retrospective cohort study with sepsis-induced CS, VA-ECMO implantation improved the clinical outcomes compared with controls not treated with VA-ECMO.…”