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Review of Pathophysiology of Cardiogenic Shock and Escalation of Mechanical Circulatory Support Devices

  • Heart Failure (HJ Eisen, Section Editor)
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Abstract

Purpose of Review

Cardiogenic shock (CS) is a complex clinical entity that continues to carry a high risk of mortality. The landscape of CS management has changed with the advent of several temporary mechanical circulatory support (MCS) devices designed to provide hemodynamic support. It remains challenging to understand the role of different temporary MCS devices in patients with CS, as many of these patients are critically ill, requiring complex care with multiple MCS device options. Each temporary MCS device can provide different types and levels of hemodynamic support. It is important to understand the risk/benefit profile of each one of them for appropriate device selection in patients with CS.

Recent Findings

MCS may be beneficial in CS patients through augmentation of cardiac output with subsequent improvement of systemic perfusion. Selecting the optimal MCS device depends on several variables including the underlying etiology of CS, clinical strategy of MCS use (bridge to recovery, bridge to transplant or durable MCS, or abridge to decision), amount of hemodynamic support needed, associated respiratory failure, and institutional preference. Furthermore, it is even more challenging to determine the appropriate time to escalate from one MCS device to another or combine different MCS devices.

Summary

In this review, we discuss the current available data published in the literature on the management of CS and propose a standardized approach for escalation of MCS devices in patients with CS. Shock teams can play an important role to help in hemodynamic-guided management and algorithm-based step-by-step approach in early initiation and escalation of temporary MCS devices at different stages of CS. It is important to define the etiology of CS, and stage of shock and recognize univentricular vs biventricular shock for appropriate device selection and escalation of therapy.

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Acknowledgements

The authors acknowledge Jason Wermers for his aid in preparing this manuscript.

Funding

The authors did not receive support from any organization for the submitted work.

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Authors and Affiliations

  1. Department of Cardiology, MedStar Georgetown University/Washington Hospital Center, 110 Irving St., NW, Suite 4B-1, Washington D.C., 20010, USA

    Mohit Pahuja, Charan Yerasi, Phillip H. Lam, Hayder Hashim, Itsik Ben-Dor, Nelson L. Bernardo, Lowell F. Satler, Farooq H. Sheikh, Samer S. Najjar & Ron Waksman

  2. Department of Cardiac Surgery, MedStar Georgetown University/Washington Hospital Center, Washington D.C., USA

    Ezequiel J. Molina

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Hayder Hashim reports serving as a consultant for and receiving speaker fees from Abbott, Cardiovascular Systems, Inc., and Boston Scientific. Samer S. Najjar reports receiving grant support from Abbott and Medtronic and receiving support for attending meetings from Abbott. Ron Waksman reports serving on the advisory boards of Abbott Vascular, Boston Scientific, Medtronic, Philips IGT, and Pi-Cardia Ltd.; being a consultant for Abbott Vascular, Biotronik, Boston Scientific, Cordis, Medtronic, Philips IGT, Pi-Cardia Ltd., Swiss Interventional Systems/SIS Medical AG, Transmural Systems Inc., and Venous MedTech; receiving institutional grant support from Amgen, Biotronik, Boston Scientific, Chiesi, Medtronic, and Philips IGT; and being an investor in MedAlliance and Transmural Systems Inc. All other authors have no competing interests to declare that are relevant to the content of this article.

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Pahuja, M., Yerasi, C., Lam, P.H. et al. Review of Pathophysiology of Cardiogenic Shock and Escalation of Mechanical Circulatory Support Devices. Curr Cardiol Rep 25, 213–227 (2023). https://doi.org/10.1007/s11886-023-01843-4

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