Cardiogenic Shock Management: A Framework for Individualized Microaxial Flow Pump Support

Cardiogenic shock (CS) is a highly heterogeneous syndrome with persistently high mortality despite advances in therapies, including temporary mechanical circulatory support. The disparate results of trials on temporary mechanical circulatory support in CS suggest that improved strategies, including better patient selection, are needed in the context of CS heterogeneity. Notably, a microaxial flow pump device has recently shown a survival benefit in ST-segment-elevation myocardial infarction-associated CS in the DanGer Shock trial (Danish-German Cardiogenic Shock), marking a positive outcome amid many negative or neutral trials. As CS phenotyping becomes increasingly important for developing tailored therapeutic strategies, it is essential to identify factors contributing to variable phenotypes, including shock severity, cause, hemodynamic profile, ventricular function, shock pattern, and patient-centered factors that may influence microaxial flow pump candidacy. Successful CS management with a microaxial flow pump may be best guided by an individualized and proactive approach, tailored to each patient's risk profile and clinical course. It is rational to implement this strategy at centers capable of providing and managing advanced temporary mechanical circulatory support options while determining candidacy for advanced heart failure therapies. Our review underscores the importance of CS phenotyping and tailoring temporary mechanical circulatory support-particularly microaxial flow pump support-to patient-specific factors that are central to optimizing outcomes in CS management.