**8. Summary and conclusion**

IABP, Impella, TandemHeart and ECMO can all be used in the setting of CS with slight differences in indications. They offer hemodynamic support, and it is recommended that one of these devices be inserted rapidly in CS if hemodynamic stability cannot be achieved with fluid resuscitation and/or pharmacotherapy. The experience with these devices in CS patients has been to start with an IABP along with vasopressors/inotropes, and if hemodynamic stability cannot be achieved, one may consider upgrading to one of the more powerful percutaneous MCS devices. Although these devices are FDA approved for the use of up to 6 h, they have been used successfully for days in patients with prolonged

Our center's experience is to insert an IABP or an Impella—depending on operator's experience—rapidly in CS patients secondary to AMI prior to attempted revascularization. We recommend—as it is endorsed by the 2015 SCAI/ACC/HFSA/STS consensus document for the use of MCS devices—that one of these devices inserted rapidly if hemodynamic stability

Other devices are being used such as the right ventricular assist devices (RVAD), which is used for the failing RV, and others. For further read on these devices and other MCS devices, refer to the 2015 SCAI/ACC/HFSA/STS expert consensus statement on the use of percutane-

The mechanical complications of AMI such as acute MR, papillary muscle rupture, ventricular septal rupture and LV free wall rupture are catastrophic, and carry very high mortality and are surgical emergencies. IABP helps stabilize these patients, especially acute MR patients,

RV failure resulting in CS also carries high mortality; ECMO or RVAD might be especially helpful in this situation. In CS secondary to massive pulmonary embolism, fibrinolysis (or mechanical thrombectomy) might be helpful, and in RV failure secondary to severe pulmonary arterial hypertension, the use of pulmonary hypertension (PH) specific therapy might

The treatment considerations in acute decompensated heart failure (ADHF) and end stage cardiomyopathy are those of the heart failure guidelines [20], and the above-mentioned MCS

In most patients with myocarditis, the course is usually self-limiting and presents with acute heart failure; on the other hand, fulminant myocarditis will present with acute severe heart failure and even CS. Close to 90% of patients with fulminant myocarditis will have full recovery with minimal long-term sequelae if recognized early. The treatment of CS secondary to fulminant myocarditis includes hemodynamic support with pharmacotherapy or MCS devices, along with high dose steroids with or without immunosuppressants if giant cell

cannot be achieved rapidly with pharmacotherapy.

**7. Treatment considerations in non-ACS related CS**

and the other MCS devices can be used in these situations as well.

provide improvement in the PA pressures and RV function.

devices can be used interchangeably.

myocarditis is diagnosed [58].

shock [43].

156 Interventional Cardiology

ous MCS [43].

Cardiogenic shock still carries high morbidity and mortality and remains the leading cause of death in acute myocardial infarction patients. Early recognition and treatment is the key to improving survival, and early revascularization in CS secondary to myocardial infarction remains the cornerstone of therapy in these patients. The early use of vasopressors/inotropes is recommended in this population, and the early use of the mechanical circulatory support devices is encouraged if hemodynamic stability cannot be achieved rapidly with pharmacotherapy.

One should keep in mind the mechanical complications of myocardial infarction and the grave prognosis if not recognized early.

There is a multitude of etiologies for non-ACS related cardiogenic shock; those should be treated similarly with vasopressors/inotropes, and MCS devices, keeping in mind guidelines directed medical therapy for those with congestive heart failure.
