The spectrum of haemodynamic support in cardiogenic shock: How to choose and use

INTRODUCTION:
Cardiogenic shock is still the most important prognostic factor for short-term mortality in acute coronary syndromes, with mortality rates approaching 50% at 30 days [1, 2]. Haemodynamic support can be achieved by inotropics and/or vasopressors as well as mechanical means such as intra-aortic balloon pumping (IABP) or percutaneous implantable left ventricular assist devices (LVAD) or complete extra-corporeal life support (ECLS) with extra-corporeal membrane oxygenation (ECMO) [3]. A schematic illustration of the different systems can be found in Figure 1. Currently there is only limited data derived from randomised trials evaluating the different percutaneous support systems. Thus, many guideline recommendations are expert recommendations with a scientific level of evidence grade C [4, 5]. In addition, the cardiogenic shock recommendations in current guidelines are relatively short, dealing mainly with interventional treatment in an acute setting. Therefore, recently dedicated guidelines for cardiogenic shock in acute myocardial infarction have been published for Germany and Austria dealing also with all aspects of intensive care treatment [6].