Acute mechanical circulatory support for cardiogenic shock: the "door to support" time

Area of Science:

• Cardiology
• Critical Care Medicine

Background:

• Cardiogenic shock (CS) is a significant cause of mortality in acute myocardial infarction patients.
• CS presents as a hemodynamic crisis with reduced cardiac output and systemic perfusion.

Purpose of the Study:

• To define key treatment objectives for CS management.
• To introduce "door to support" time as a therapeutic target.
• To present a classification scheme for CS subtypes based on filling pressures.

Main Methods:

• Review of current literature on CS management.
• Discussion of hemodynamic assessment and acute mechanical circulatory support (AMCS) device selection.
• Development of a novel CS classification system.

Main Results:

• Identified four critical treatment objectives for CS.
• Proposed "door to support" time as a crucial metric for improving outcomes.
• Introduced a classification for CS subtypes using cardiac filling pressures.

Conclusions:

• Optimizing CS management necessitates clear treatment goals and timely interventions.
• Early hemodynamic assessment and appropriate AMCS device selection are vital.
• The proposed classification may aid in personalized CS treatment strategies.