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[Cardiac support and replacement systems].

T Graf1,2, H Thiele3,4

  • 1Universitäres Herzzentrum Lübeck Medizinische Klinik II (Kardiologie, Angiologie, Intensivmedizin), Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland.

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Summary
This summary is machine-generated.

Mechanical circulatory support, including left-ventricular assist devices (LVAD) and extracorporeal life support (ECLS), is used for refractory cardiogenic shock. However, high mortality persists, and large studies are lacking.

Keywords:
Cardiogenic shockExtracorporeal membrane oxygenationHypothermiaMyocardial infarctionMyocardial revascularization

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Area of Science:

  • Cardiology
  • Intensive Care Medicine
  • Mechanical Circulatory Support

Background:

  • Refractory cardiogenic shock has high mortality despite current treatments.
  • Mechanical cardiac support devices like LVAD and ECLS are increasingly used in ICUs.
  • Current guidelines recommend mechanical support only for therapy-refractory shock.

Purpose of the Study:

  • To review the current role and limitations of mechanical circulatory support in cardiogenic shock.
  • To discuss the application of LVAD and ECLS in various forms of cardiogenic shock.
  • To highlight the need for further research on mechanical support outcomes.

Main Methods:

  • Review of current literature and guidelines on mechanical circulatory support for cardiogenic shock.
  • Discussion of the differences between LVAD and ECLS.
  • Analysis of registry data for ECLS in specific scenarios like E-CPR and hypothermia.

Main Results:

  • Mechanical support is established for refractory cardiogenic shock but mortality remains high.
  • No large randomized trials evaluate mechanical support systems for cardiogenic shock outcomes.
  • ECLS may reduce mortality in selected E-CPR patients and is considered for hypothermia.

Conclusions:

  • Mechanical support should be reserved for refractory cardiogenic shock, not first-line treatment.
  • ECLS can serve as bridging therapy for noninfarct-related cardiogenic shock and in E-CPR.
  • Early ECLS consideration is advised for severe hypothermia with cardiac arrest.