Acute mechanical circulatory support for cardiogenic shock: the "door to support" time [version 1; peer review: 3 approved]

• Published in: F1000 research Vol. 6; p. 737
• Main Authors: Esposito, Michele L, Kapur, Navin K
• Format: Journal Article
• Language: English
• Published: England Faculty of 1000 Ltd 2017; F1000Research; F1000 Research Ltd
• Subjects: Acute Cardiovascular Problems; Coronary Artery Disease; Heart Failure; Hemodynamics; Review; ventricular unloading; cardiogenic shock; percutaneous ventricular assist device; acute mechanical circulatory support; hemodynamics
• ISSN: 2046-1402; 2046-1402
• DOI: 10.12688/f1000research.11150.1

Cardiogenic shock (CS) remains a major cause of in-hospital mortality in the setting of acute myocardial infarction. CS begins as a hemodynamic problem with impaired cardiac output leading to reduced systemic perfusion, increased residual volume within the left and right ventricles, and increased cardiac filling pressures. A critical step towards the development of future algorithms is a clear understanding of the treatment objectives for CS. In this review, we introduce the "door to support" time as an emerging target of therapy to improve outcomes associated with CS, define four key treatment objectives in the management of CS, discuss the importance of early hemodynamic assessment and appropriate selection of acute mechanical circulatory support (AMCS) devices for CS, and introduce a classification scheme that identifies subtypes of CS based on cardiac filling pressures.