[Mechanical circulatory support in cardiogenic shock]

Acute revascularization is of utmost importance in acute heart failure and infarct-related cardiogenic shock. Besides this therapy of the underlying disease, methods for rapid restoration of arterial blood pressure and sufficient organ perfusion are at the forefront. If conventional means such as volume management, inotropic support, or infusion of vasopressors fail in this situation, mechanical circulatory support may be indicated in selected cases. Noninvasive systems for automatic thorax compression are used for extended cardiopulmonary resuscitation. Intra-aortic balloon counter pulsation (IABP) and axial turbine pumps provide circulatory support and left ventricular unloading. Extracorporeal membrane oxygenation (ECMO) devices consisting of a membrane oxygenator in combination with a centrifugal pump also support the gas exchange in cases of acute pulmonary failure. Using mechanical circulatory support allows lifesaving further diagnostic and therapeutic measures in selected cases, despite limited evidence. They help to restore sufficient arterial blood pressure and therefore organ perfusion in acute heart failure and cardiogenic shock.