The role of temporary mechanical circulatory support in heart failure

Figures

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  Figure 1. Acute heart failure and cardiogenic shock networks. The implementation of multi-disciplinary teams in managing patient care requires a coordinated effort and potential transfer among the different hospital levels (1–4).

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  Figure 2. Cardiogenic shock management. The key in cardiogenic shock management is early recognition and management of these critically ill patients. As the downward spiral continues, the cardiogenic shock Society for Cardiovascular Angiography and Intervention (SCAI) level will increase, the systemic inflammatory reaction syndrome (SIRS) will increase (cytokine rush), and the biomarkers of ischaemia (lactate) will rise. The multi-disciplinary team is central in this decision process. Depending on the patient’s profile, the underlying aetiology and timing of presentation (early vs. late), the multi-disciplinary team will decide on a patient- and disease-tailored treatment approach. The same multi-disciplinary team will have the task to decide early—ideally before therapy is started—to which bridge-to-group the patient belongs once weaning from drug and/or mechanical circulatory support proves unsuccessful (long-term mechanical support vs. heart transplant vs. futility). MDT, multi-disciplinary team; MCS, mechanical circulatory support; dLVAD, durable left ventricular assisted device; HTx, heart transplantation.