The New Era of Cardiogenic Shock: Progress in Mechanical Circulatory Support

In recent decades, multiple left and right ventricular assist devices (VAD) have been developed, and the utilization of these devices has grown exponentially. We discuss the most common temporary mechanical circulatory support (tMCS) devices used for patients in cardiogenic shock, including the intra-aortic balloon pump (IABP), transvalvular axial flow support systems (Impella®), the Tandem™ collection, and extracorporeal membrane oxygenation (ECMO).

In 2018 the United Network for Organ Sharing (UNOS) introduced new listing criteria for candidates awaiting heart transplantation in the USA. Analysis of the first 1300 transplants under these new listing criteria has shown that higher-risk patients are now undergoing transplantation. As technology has advanced, becoming more sophisticated and miniaturized, a new era has emerged with more rapidly deployable tMCS devices. For some patients presenting in cardiogenic shock, support with these tMCS devices can be a bridge to a more durable option. For others, their only option may be support with the hope of native cardiac recovery. Understanding the pros and cons of each device can lead to most appropriate utilization for the ultimate intended goal.