Abstract:
PURPOSE OF REVIEW:Temporary circulatory support (TCS) with short-term mechanical circulatory support (MCS) devices is increasingly used as a salvage therapy for patients with refractory cardiogenic shock. This article provides an overview of current devices, their indications and management, and discusses results of recent case series and trials. RECENT FINDINGS:Percutaneous active MCS devices (Impella, TandemHeart…) and venoarterial extracorporeal membrane oxygenation (VA-ECMO) are utilized as a bridge to 'decision' that includes weaning after cardiac function recovery, transplantation, long-term MCS and withdrawal in case of futility. VA-ECMO is considered the first-line TCS since it allows rapid improvement in oxygenation, is less expensive, and is also suitable for patients with biventricular failure. Combining Impella or intra-aortic balloon pump support with ECMO might decrease left ventricular pressure and improve outcomes. Sepsis-associated cardiomyopathy, massive pulmonary embolism, arrhythmic storm and Takotsubo-like cardiomyopathy are among emerging indications for TCS. SUMMARY:TCS have become the cornerstone of the management of patients with cardiogenic shock, although the evidence supporting their efficacy is limited. VA-ECMO is considered the first-line option, with a growing number of accepted and emerging indications. Randomized clinical trials are now needed to determine the respective place of different MCS devices in cardiogenic shock treatment strategies.
journal_name
Curr Opin Crit Carejournal_title
Current opinion in critical careauthors
Pineton de Chambrun M,Bréchot N,Combes Adoi
10.1097/MCC.0000000000000520subject
Has Abstractpub_date
2018-08-01 00:00:00pages
286-291issue
4eissn
1070-5295issn
1531-7072journal_volume
24pub_type
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journal_title:Current opinion in critical care
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journal_title:Current opinion in critical care
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journal_title:Current opinion in critical care
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