Temporary mechanical circulatory support in cardiogenic shock.

Abstract

Cardiogenic shock (CS) remains a heterogeneous syndrome associated with persistently high mortality despite advances in temporary mechanical circulatory support. One recent randomized controlled trial suggested a mortality benefit of a percutaneous microaxial flow pump in a cohort of patients with ST-elevation myocardial infarction complicated by CS, whereas routine veno-arterial extracorporeal membrane oxygenation in populations with acute myocardial infarction complicated by CS has not improved survival and is associated with higher complication rates. These findings underscore the importance of phenotype-driven patient selection, incorporating the Society for Cardiovascular Angiography and Interventions (SCAI) and Shock Academic Research Consortium (SHARC) classifications to guide device selection, timing, escalation, and de-escalation. This clinical consensus statement from the European Association of Percutaneous Cardiovascular Interventions (EAPCI) and the Association for Acute CardioVascular Care (ACVC) of the European Society of Cardiology (ESC) updates the 2020 expert consensus document and provides updated practical guidance based on the recent evidence on the use of temporary mechanical circulatory support in acute myocardial infarction complicated by CS. Emphasis is placed on patient/device selection according to recent evidence, multidisciplinary shock teams, regionalized hub-and-spoke systems, structured protocols for escalation and futility, and the integration of contemporary trial data and best practices to optimize outcomes in this high-risk population.