Mechanical Circulatory Support in Cardiogenic Shock: A Narrative Review

Cardiogenic shock (CS) remains a critical condition with high mortality rates, often arising from acute myocardial infarction and advanced heart failure. Despite advancements in medical therapy, traditional interventions frequently fall short of reversing the profound hemodynamic instability seen in CS. Mechanical circulatory support (MCS) devices have emerged as crucial therapeutic options, offering temporary stabilization and bridging to recovery, heart transplantation, or long-term ventricular assist device implantation. This narrative review explores the current landscape of MCS in CS, highlighting the various types of support devices, including intra-aortic balloon pumps (IABP), veno-arterial extracorporeal membrane oxygenation (VA-ECMO), and percutaneous ventricular assist devices (pVADs) such as Impella and TandemHeart. We examine their mechanisms of action, clinical indications, and outcomes alongside the challenges and complications associated with their use. Additionally, we discuss the evolving guidelines and the role of MCS in contemporary CS management, emphasizing the need for timely intervention and a multidisciplinary approach. The review underscores the importance of individualized patient selection and device choice to optimize outcomes in this critically ill population.