Devices for mechanical circulatory support and strategies for their management in cardiogenic shock

Cardiogenic shock (CS) is a low cardiac output state resulting in end-organ hypoperfusion and hypoxia, which, if untreated, leads to an irreversible multiorgan failure. Acute coronary syndrome is the most common cause of CS, with a high prevalence of patients with multivessel disease. Cardiogenic shock management remains a challenge, since mortality rates are still high and have not declined over the last 20 years. The treatment strategy of CS in patients with acute coronary syndrome needs to take into account both the presence of myocardial ischemia and tissue hypoperfusion. The first part of this review focuses on the characteristics, hemodynamic profile, and available evidence of the mechanical circulatory support devices for an optimal patient-device matching. The second part focuses on the management strategy of CS in terms of myocardial revascularization and hemodynamic support in light of the most recent available evidence.