Mechanical Assist Devices in Cardiogenic Shock Complicating Myocardial Infarction

Abstract

In acute myocardial infarction cardiogenic shock is still one of the most feared complications. Although medical and interventional treatment of myocardial infarction improved significantly over the last decades mortality of cardiogenic shock patients remains on unacceptable high levels with 30-day mortality rates of 40-50 %. To date only an early revascularization of the culprit infarct lesion is the only intervention with proven survival benefit for patients. Active mechanical assist devices were introduced more than two decades ago to support left ventricular function as addition to medical treatment with inotropes and vasopressors. Yet, to date only insufficient date exists for these devices in cardiogenic shock patients and therefore no general recommendation can be given. This viewpoint gives an overview about the most used devices. The different mechanism of left ventricular support will be explained, and the current evidence discussed. Furthermore, ongoing randomized controlled trials are highlighted.