Key result
Active left ventricular assist devices may offer a treatment option in refractory cardiogenic shock given the lack of benefit with intra-aortic balloon pumping, though robust outcome data is lacking.
While IABP is no longer routinely recommended for cardiogenic shock, active percutaneous LVADs offer hemodynamic benefits for refractory cases, though their use requires careful patient selection due to a lack of robust outcome data and higher complication rates.
May warrant selective active LVAD use in refractory shock; leaves open need for RCTs on outcomes and complications.
Copyright © Polskie Towarzystwo Kardiologiczne INTRODUCTION Cardiogenic shock is still the most important prognostic factor for short-term mortality in acute coronary syndromes, with mortality rates approaching 50% at 30 days [1, 2]. Haemodynamic support can be achieved by inotropics and/or vasopressors as well as mechanical means such as intra-aortic balloon pumping (IABP) or percutaneous implantable left ventricular assist devices (LVAD) or complete extra-corporeal life support (ECLS) with extra-corporeal membrane oxygenation (ECMO) [3]. A schematic illustration of the different systems can be found in Figure 1. Currently there is only limited data derived from randomised trials evaluating the different percutaneous support systems. Thus, many guideline recommendations are expert recommendations with a scientific level of evidence grade C [4, 5]. In addition, the cardiogenic shock recommendations in current guidelines are relatively short, dealing mainly with interventional treatment in an acute setting. Therefore, recently dedicated guidelines for cardiogenic shock in acute myocardial infarction have been published for Germany and Austria dealing also with all aspects of intensive care treatment [6].
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Fuernau et al. (2013) conducted a review in Cardiogenic shock. Mechanical haemodynamic support (LVAD, ECLS, IABP) was evaluated. Active left ventricular assist devices may offer a treatment option in refractory cardiogenic shock given the lack of benefit with intra-aortic balloon pumping, though robust outcome data is lacking.
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