**1. Introduction**

Despite improved treatment and outcomes for many forms of cardiovascular disease, cardiogenic shock (CS) remains a common cause of mortality [1–3]. CS is classically recognized as a state of inadequate cardiac output, which if left uncorrected, may lead to tissue malperfusion and organ failure. Vasopressors and inotropes become necessary as conventional treatment options to maintain adequate organ perfusion [4].

Over the past decade, only marginal improvements have been noted in outcomes and mortality rates of CS. When complicated by acute myocardial infarction (AMI-CS), the mortality rate ranges from 50 to 60%, while mortality from acute decompensated heart failure-related CS is approximately 40% [5].

Whether due to impaired function of the right ventricle (RV), left ventricle (LV), or both, implementation of prompt medical management to correct low cardiac output and hypotension is necessary. However, when medical management fails, use of acute mechanical circulatory support (MCS) should be considered [2]. In this chapter, we focus on a particular device, the ProtekDuo® cannula, and its role in

the management of patients with cardiogenic shock with acute RV failure. We also discuss its evolving roles in the treatment of LV and biventricular failure, both alone and in combination with other devices, as well as use in the treatment of combined cardiac and respiratory failure, which commonly co-exist in clinical practice.
