Cardiogenic shock in the setting of an acute STEMI generally occurs due to left ventricular (LV) dysfunction in approximately 80% of cases ( 2). IntroductionĪpproximately 10% to 15% of patients with acute ST segment elevated myocardial infarction (STEMI) will develop cardiogenic shock which equates to approximately 60,000 cases per year ( 1). Video Temporary support strategies for cardiogenic shock: extracorporeal membrane oxygenation, percutaneous ventricular assist devices and surgically placed extracorporeal ventricular assist devices. Effective methodologies that are evidence based will help physicians in their decision-making when considering temporary MCS for patients. Going forward, researchers need to focus on developing a systematic approach to problem solving in utilizing MCS for patients with cardiogenic shock. Perhaps we have hit the “glass ceiling” with current strategies and it is time to explore novel strategies to salvage not only the heart but more importantly the patient and potentially more of both.
CARDIOHELP MAQUET MANUAL TRIAL
The conventional focus since the SHOCK trial has centered on revascularization strategies and the subsequent medical management of these patients post-PCI with ever diminishing returns. Nonetheless even in the age of percutaneous coronary intervention (PCI) of the infarct related artery, survival rates continue to be only approximately 50%. Substantial mortality gains in the acute myocardial infarction cardiogenic shock (AMI-CS) population were observed with the reported outcomes of the SHOCK trial in 1999 compared to previous populations with AMI-CS. The majority of clinical pathways and paradigms utilized in the treatment and management of cardiogenic shock with temporary mechanical circulatory support (MCS) are largely based on individual physician intuition and ad hoc problem-solving.
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