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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
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Mechanical circulatory support in acute cardiogenic shock
Mubashar H Khan1, Brian J Corbett1, Steven M Hollenberg1
1Cooper University Hospital One Cooper Plaza, Camden, NJ 08103 USA.
F1000Prime Reports
|November 7, 2014
Summary
Mechanical circulatory support devices like IABPs, ECMO, and percutaneous ventricular assist devices are used for cardiogenic shock. However, current evidence does not definitively prove their mortality benefit, necessitating further research.
Area of Science:
- Cardiology
- Critical Care Medicine
- Cardiovascular Surgery
Background:
- Cardiogenic shock, a severe complication of acute myocardial infarction, has high mortality despite treatment advancements.
- Vasoactive agents have limitations, often requiring mechanical circulatory support (MCS) after revascularization.
Purpose of the Study:
- To review the current landscape of MCS devices used in cardiogenic shock.
- To evaluate the evidence for the efficacy and mortality benefit of various MCS devices.
Main Methods:
- Review of existing literature on intra-aortic balloon pumps (IABPs), extracorporeal membrane oxygenation (ECMO), and percutaneous ventricular assist devices (pVADs).
- Analysis of outcomes from retrospective and prospective randomized studies comparing these devices.
Main Results:
- IABPs may improve mortality with fibrinolysis but not necessarily with percutaneous coronary interventions.
- ECMO is used for refractory shock, but randomized trials have not confirmed a mortality benefit.
- pVADs offer hemodynamic advantages over IABPs but lack demonstrated mortality benefit in current studies.
Conclusions:
- No definitive mortality benefit has been established for ECMO or pVADs in cardiogenic shock.
- Further randomized controlled trials are essential to clarify the optimal role and selection of MCS devices.
- The high mortality associated with cardiogenic shock underscores the need for improved therapeutic strategies.
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