Percutaneous mechanical circulatory support in cardiogenic shock

Cardiogenic shock is the most common cause of death in patients with acute myocardial infarction. Around 10% of the patients with an ST-segment elevation myocardial infarction develop cardiogenic shock. Mortality in cardiogenic shock has been reduced over the last few decades, but it still remains around 50%. Treatment of cardiogenic shock after acute myocardial infarction includes revascularization of the occluded coronary vessel and increasing blood pressure by pharmacological treatment with inotropes and vasopressors or additionally with mechanical circulatory support. The most commonly used mechanical support device still is the intra-aortic balloon pump (IABP). However, in the last decades several other mechanical support devices have been introduced, leading to more clinical experience and insights in the usage of these devices. Mechanical circulatory support has become a field of development and research on its own. This thesis focuses on the use of the mechanical support devices in cardiogenic shock after acute myocardial infarction. Part I describes lessons from observational clinical experience with the Impella device in various clinical settings. Part II describes the randomized comparison of Impella with IABP in cardiogenic pre-shock and severe cardiogenic shock. Part III describes the available data on the use of extracorporeal life support during refractory cardiac arrest and cardiogenic shock.