Korean Circ J.  2019 Mar;49(3):197-213. 10.4070/kcj.2018.0443.

Mechanical Circulatory Support in the Cardiac Catheterization Laboratory for Cardiogenic Shock

• Ryan M
• Briceno N
• Perera D

• KMID: 2438531
• DOI: http://doi.org/10.4070/kcj.2018.0443

Abstract

Despite the development of acute revascularisation, the mortality rate for cardiogenic shock remains around 50%. Mechanical circulatory support devices have long held promise in improving outcomes in shock, but high-quality evidence of benefit has not been forthcoming. In this article we review the currently available devices for treating shock, their physiological effects and the evidence base for their use in practice. We subsequently look ahead within this developing field, including new devices and novel indications for established technology.

Keyword

Shock, cardiogenic; Myocardial infarction; Extracorporeal membrane oxygenation

MeSH Terms

Cardiac Catheterization*
Cardiac Catheters*
Extracorporeal Membrane Oxygenation
Mortality
Myocardial Infarction
Shock
Shock, Cardiogenic*

Figure

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  Figure 1 The intra-aortic balloon pump waveform.

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  Figure 2 Impella catheters and control console.

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  Figure 3 Venoarterial (A) and veno-venous arterial extra-corporeal membrane oxygenation circuit configurations (B).

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  Figure 4 Time-to-event curves through 30 days after randomisation for the primary endpoint of all-cause mortality in the IABP-SHOCK II trial. Event rates represent Kaplan-Meier estimates.CI = confidence interval; IABP = intra-aortic balloon pump.

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  Figure 5 All cause mortalities in the BCIS-1 trial. Reproduced with permission from Perera D, et al. Long-term mortality data from the Balloon Pump-Assisted Coronary Intervention Study (BCIS-1): a randomized, controlled trial of elective balloon counterpulsation during high-risk percutaneous coronary intervention. Circulation 2013;127:207-212.40)CI = confidence interval; IABP = intra-aortic balloon pump.

• 

  Figure 6 Kaplan-Meier curves of major adverse events to 90 days. (A) Intent-to-treat population. (B) Per protocol population. IABP indicates intra-aortic balloon pump. Reproduced with permission from O'Neill WW, et al. A prospective, randomized clinical trial of hemodynamic support with Impella 2.5 versus intra-aortic balloon pump in patients undergoing high-risk percutaneous coronary intervention: the PROTECT II study. Circulation 2012;126:1717-1727.42)IABP = intra-aortic balloon pump.

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