Skip to main content
SpringerLink
Log in

Temporary Mechanical Circulatory Support for Cardiogenic Shock

  • Heart Failure (W Tang, Section Editor)
  • Published:
Current Treatment Options in Cardiovascular Medicine Aims and scope Submit manuscript

Opinion statement

Cardiogenic shock is a life-threatening presentation of severe heart failure with high morbidity and mortality. Given the modest increased in cardiac output and neutral/negative survival benefits with today’s available inotropes (namely, dobutamine and milrinone), the use of mechanical circulatory support (MCS) has increased dramatically over the past 2 decades. In this review article, we discuss the physiologic concept, clinical evidence of benefit, and current use and indications/potential complications of the four most commonly used devices for MCS: intra-aortic balloon pump, Impella percutaneous ventricular assist device, TandemHeart, and extracorporeal membrane oxygenation (ECMO). We also compare these devices in terms of complexity of implantation and hemodynamic effects.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Kolte D, Khera S, Aronow WS, Mujib M, Palaniswamy C, Sule S, et al. Trends in incidence, management, and outcomes of cardiogenic shock complicating ST-elevation myocardial infarction in the United States. J Am Heart Assoc. 2014;3(1):e000590.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Pagani FD, Lynch W, Swaniker F, Dyke DB, Bartlett R, Koelling T, et al. Extracorporeal life support to left ventricular assist device bridge to heart transplant: a strategy to optimize survival and resource utilization. Circulation. 1999;100(19 Suppl):Ii206–10.

    CAS  PubMed  Google Scholar 

  3. Sanborn TA, Sleeper LA, Bates ER, Jacobs AK, Boland J, French JK, et al. Impact of thrombolysis, intra-aortic balloon pump counterpulsation, and their combination in cardiogenic shock complicating acute myocardial infarction: a report from the SHOCK Trial Registry. Should we emergently revascularize occluded coronaries for cardiogenic shock? J Am Coll Cardiol. 2000;36(3 Suppl A):1123–9.

    Article  CAS  PubMed  Google Scholar 

  4. • Ergle K, Parto P, Krim SR. Percutaneous ventricular assist devices: a novel approach in the management of patients with acute cardiogenic shock. Ochsner J. 2016;16(3):243–9. This concise easy to read review, provides the reader with the mechanism of action, indication and contraindication along with the similarities/differences between percutaneous ventricular assist device.

    PubMed  PubMed Central  Google Scholar 

  5. • Werdan K, Gielen S, Ebelt H, Hochman JS. Mechanical circulatory support in cardiogenic shock. Eur Heart J. 2014;35(3):156–67. This state of the art review article discusses in depth the pathophysiology of cardiogenic shock, its poor prognosis, and the percutaneous assist device available for support. It is a must read for medical students, residents, or fellows interested in the field.

    Article  CAS  PubMed  Google Scholar 

  6. Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction—executive summary. A report of the American College of Cardiology/American Heart Association task force on practice guidelines (writing committee to revise the 1999 guidelines for the management of patients with acute myocardial infarction). J Am Coll Cardiol. 2004;44(3):671–719.

    Article  PubMed  Google Scholar 

  7. Van de Werf F, Bax J, Betriu A, Blomstrom-Lundqvist C, Crea F, Falk V, et al. Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: the task force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology. Eur Heart J. 2008;29(23):2909–45.

    Article  PubMed  Google Scholar 

  8. Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V, et al. 2014 ESC/EACTS guidelines on myocardial revascularization: the task force on myocardial revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J. 2014;35(37):2541–619.

    Article  PubMed  Google Scholar 

  9. O’Gara PT, Kushner FG, Ascheim DD, Casey DE Jr, Chung MK, de Lemos JA, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines. Circulation. 2013;127(4):e362–425.

    Article  PubMed  Google Scholar 

  10. • Thiele H, Schuler G, Neumann FJ, Hausleiter J, Olbrich HG, Schwarz B, et al. Intraaortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock: design and rationale of the intraaortic balloon pump in cardiogenic shock II (IABP-SHOCK II) trial. Am Heart J. 2015;169(4):e7–8. This randomized prospective trial showed that IABP did not reduce thirty day mortality in cardiogenic shock patient complicating acute MI who received an early revascularization therapy. The most significant fall out of this trial is the eventual downgrading of IABP indication for use in cardiogenic shock complicating MI from class I to class II.

    Article  PubMed  Google Scholar 

  11. Thiele H, Schuler G, Neumann FJ, Hausleiter J, Olbrich HG, Schwarz B, et al. Intraaortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock: design and rationale of the Intraaortic balloon pump in cardiogenic shock II (IABP-SHOCK II) trial. Am Heart J. 2012;163(6):938–45.

    Article  PubMed  Google Scholar 

  12. Seyfarth M, Sibbing D, Bauer I, Frohlich G, Bott-Flugel L, Byrne R, et al. A randomized clinical trial to evaluate the safety and efficacy of a percutaneous left ventricular assist device versus intra-aortic balloon pumping for treatment of cardiogenic shock caused by myocardial infarction. J Am Coll Cardiol. 2008;52(19):1584–8.

    Article  PubMed  Google Scholar 

  13. Gaudard P, Mourad M, Eliet J, Zeroual N, Culas G, Rouviere P, et al. Management and outcome of patients supported with Impella 5.0 for refractory cardiogenic shock. Critical Care (London, England). 2015;19:363.

    Article  Google Scholar 

  14. Anderson MB, Goldstein J, Milano C, Morris LD, Kormos RL, Bhama J, et al. Benefits of a novel percutaneous ventricular assist device for right heart failure: the prospective RECOVER RIGHT study of the Impella RP device. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation. 2015;34(12):1549–60.

    Article  Google Scholar 

  15. Thiele H, Sick P, Boudriot E, Diederich KW, Hambrecht R, Niebauer J, et al. Randomized comparison of intra-aortic balloon support with a percutaneous left ventricular assist device in patients with revascularized acute myocardial infarction complicated by cardiogenic shock. Eur Heart J. 2005;26(13):1276–83.

    Article  PubMed  Google Scholar 

  16. Briceno N, Kapur NK, Perera D. Percutaneous mechanical circulatory support: current concepts and future directions. Heart. 2016;102(18):1494–507.

    Article  PubMed  Google Scholar 

  17. Hoefer D, Ruttmann E, Poelzl G, Kilo J, Hoermann C, Margreiter R, et al. Outcome evaluation of the bridge-to-bridge concept in patients with cardiogenic shock. Ann Thorac Surg. 2006;82(1):28–33.

    Article  PubMed  Google Scholar 

  18. Bermudez CA, Rocha RV, Toyoda Y, Zaldonis D, Sappington PL, Mulukutla S, et al. Extracorporeal membrane oxygenation for advanced refractory shock in acute and chronic cardiomyopathy. Ann Thorac Surg. 2011;92(6):2125–31.

    Article  PubMed  Google Scholar 

  19. Negi SI, Sokolovic M, Koifman E, Kiramijyan S, Torguson R, Lindsay J, et al. Contemporary use of veno-arterial extracorporeal membrane oxygenation for refractory cardiogenic shock in acute coronary syndrome. The Journal of Invasive Cardiology. 2016;28(2):52–7.

    PubMed  Google Scholar 

  20. Khorsandi M, Dougherty S, Sinclair A, Buchan K, MacLennan F, Bouamra O, et al. A 20-year multicentre outcome analysis of salvage mechanical circulatory support for refractory cardiogenic shock after cardiac surgery. J Cardiothorac Surg. 2016;11(1):151.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Aso S, Matsui H, Fushimi K, Yasunaga H. In-hospital mortality and successful weaning from venoarterial extracorporeal membrane oxygenation: analysis of 5,263 patients using a national inpatient database in Japan. Critical Care (London, England). 2016;20:80.

    Article  Google Scholar 

  22. Soleimani B, Pae WE. Management of left ventricular distension during peripheral extracorporeal membrane oxygenation for cardiogenic shock. Perfusion. 2012;27(4):326–31.

    Article  CAS  PubMed  Google Scholar 

  23. Rupprecht L, Florchinger B, Schopka S, Schmid C, Philipp A, Lunz D, et al. Cardiac decompression on extracorporeal life support: a review and discussion of the literature. ASAIO journal (American Society for Artificial Internal Organs : 1992). 2013;59(6):547–53.

    Article  Google Scholar 

  24. • Ouweneel DM, Eriksen E, Sjauw KD, van Dongen IM, Hirsch A, Packer EJ, et al. Percutaneous mechanical circulatory support versus intra-aortic balloon pump in cardiogenic shock after acute myocardial infarction. J Am Coll Cardiol. 2017;69(3):278–87. This randomized prospective multicenter controlled trial showed that routine treatment with Impella CP in cardiogenic shock patients complicating MI did not reduce thirty day mortality compared to IABP which add to the confusion and difficulty in comparing various LV assist devices and choosing the right one for the appropriate patient.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of Kentucky Gill Heart Institute, First Floor, Room G100, 1000 S. Limestone, Lexington, KY, 40536, USA

    Jean Touchan MD & Maya Guglin MD, PhD

Authors
  1. Jean Touchan MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maya Guglin MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Maya Guglin MD, PhD.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Heart Failure

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Touchan, J., Guglin, M. Temporary Mechanical Circulatory Support for Cardiogenic Shock. Curr Treat Options Cardio Med 19, 77 (2017). https://doi.org/10.1007/s11936-017-0576-9

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11936-017-0576-9

Keywords

Search

Navigation