Vasyliv M. S., Sadova-Chuba Z. T., Harbar M. O.

OVERVIEW OF CONTEMPORARY METHODS OF TEMPORARY MECHANICAL CIRCULATORY SUPPORT IN CARDIOGENIC SHOCK ASSOCIATED WITH HEART FAILURE

---

Show/Download

About the author:

Vasyliv M. S., Sadova-Chuba Z. T., Harbar M. O.

Heading:

LITERATURE REVIEWS

Type of article:

Scientific article

Annotation:

Cardiogenic shock (CS) is a clinical syndrome resulting from a sharp decrease in cardiac output, which leads to hypoperfusion of vital organs and tissues. Despite the achievements of pharmacological therapy, mortality in CS re- mains high. In this regard, the role of temporary mechanical circulatory support (TMCS) methods is increasing, which allows for stabilising hemodynamics, ensuring adequate organ perfusion, and reducing the load on the myocardium. Such devices can serve as a bridge to restoring heart function, provide long-term mechanical support, or facilitate transplantation. Over the past decade, significant progress has been noted in the development of TMCS technolo- gies, among which intraaortic balloon counterpulsation (IABP), microaxial pump systems (Impella), transseptal ven- tricular assist devices (TandemHeart) and extracorporeal membrane oxygenation (ECMO) are the most widely used. The purpose of this study is to examine various options for modern methods of temporary mechanical circulatory support, to compare their availability, advantages, and disadvantages, as documented in modern literature, to opti- mise the intensive care of patients with acute heart failure. Bibliosemantic, comparative and systematic analysis methods were used. The results of this study are based on data from the analysis of modern literature, as well as the results of randomised trials and meta-analyses devoted to the study of modern methods of temporary mechanical circulatory support. The use of MCS devices in patients with progressive heart failure unresponsive to conventional intensive care management provides hemodynamic support and stabilization and increases patient survival. Rather than viewing these devices as competing technologies, it is essential to understand each device individually to leverage its unique properties in various clinical situations. Early use of MCS devices in CS is associated with better outcomes because they mitigate the adverse effects of systemic hypoperfusion on target organs and reduce the need for inotropes/ vasopressors, thereby minimising myocardial oxygen consumption and improving microcirculation.

Tags:

Bibliography:

1. Tarvasmäki T, Lassus J, Varpula M, Sionis A, Sund R, Køber L, et al. Current real-life use of vasopressors and inotropes in cardiogenic shock – adrenaline use is associated with excess organ injury and mortality. Crit Care. 2016;20:208.
2. Vallabhajosyula S, Prasad A, Sandhu GS, Dunlay SM, Gersh BJ, Gulati R, et al. Ten-year trends, predictors and outcomes of mechanical circulatory support in percutaneous coronary intervention for acute myocardial infarction with cardiogenic shock. EuroIntervention. 2021;16:e1254-e1261.
3. Strom JB, Zhao Y, Shen C, Ferreira JP, Vaduganathan M, Bhatt DL, et al. National trends, predictors of use, and in-hospital outcomes in mechanical circulatory support for cardiogenic shock. EuroIntervention. 2018;13:e2152-e2159.
4. Khera R, Cram P, Lu X, Vyas A, Gerke A, Rosenthal GE. Trends in the use of percutaneous ventricular assist devices: analysis of national inpatient sample data, 2007. JAMA Intern Med. 2014;174(6):941-950.
5. Krishna M, Zacharowski K. Principles of intra-aortic balloon pump counterpulsation. Contin Educ Anaesth Crit Care Pain. 2009;9(1):24-28.
6. Tanaka A, Tuladhar S, Onsager D, Wood K, Durham LA, Fukamachi K. The subclavian intraaortic balloon pump: a compelling bridge device for advanced heart failure. Ann Thorac Surg. 2015;100:2151-2157.
7. Trost JC, Hillis LD. Intra-aortic balloon counterpulsation. Am J Cardiol. 2006;97:1391-1398.
8. de Jong MM, Lorusso R, Al Awami F, Mariani MA, Morshuis M, Schmid C, et al. Vascular complications following intra-aortic balloon pump implantation: an updated review. Perfusion. 2018;33:96-104.
9. Wong ASK, Sin SWC. Short-term mechanical circulatory support (intra-aortic balloon pump, Impella, extracorporeal membrane oxygenation, TandemHeart): A review. Ann Transl Med. 2020;8:829.
10. Saito S, Okubo S, Matsuoka T, Nishida T, Ueno H, Takahashi A, et al. Impella – Current issues and future expectations for the percutaneous, microaxial flow left ventricular assist device. J Cardiol. 2024;83:228-235.
11. Orvin K, Perl L, Landes U, Vaknin-Assa H, Codner P, Assali A, et al. Percutaneous mechanical circulatory support from the collaborative multicenter Mechanical Unusual Support in TAVI (MUST) Registry. Catheter Cardiovasc Interv. 2021;98:E862-E869.
12. Manzo-Silberman S, Fichet J, Mathonnet A, Pinaud F, Dumas F, Cariou A, et al. Percutaneous left ventricular assistance in post cardiac arrest shock: comparison of intra-aortic blood pump and Impella Recover LP2.5. Resuscitation. 2013;84:609-615.
13. Vranckx P, Meliga E, de Jaegere P, van Domburg RT, Serruys PW. The TandemHeart®, percutaneous transseptal left ventricular assist device: a safeguard in high-risk percutaneous coronary interventions. The six-year Rotterdam experience. EuroIntervention. 2008;4(3):385- 391.
14. Smith L, Peters A, Mazimba S, Truesdell AG, O’Neill WW, Kapur NK. Outcomes of patients with cardiogenic shock treated with TandemHeart® percutaneous ventricular assist device: Importance of support indication and definitive therapies as determinants of prognosis. Catheter Cardiovasc Interv. 2018;92:1173-1181.
15. Kar B, Gregoric ID, Basra SS, Idelchik GM, Loyalka P. The percutaneous ventricular assist device in severe refractory cardiogenic shock. J Am Coll Cardiol. 2011;57:688-696.
16. Wood K, Ayers B, Gosev I, Lanfranchi M, Hirose H, Cohn WE, et al. Venoarterial ECMO without routine systemic anticoagulation decreases adverse events. Ann Thorac Surg. 2020;109(5):1458-1466.
17. Ostadal P, Rokyta R, Karasek J, Kruger A, Kovarnik T, Malek F, et al. Extracorporeal Membrane Oxygenation in the Therapy of Cardiogenic Shock: Results of the ECMO-CS Randomized Clinical Trial. Circulation. 2023;147:454-464.
18. Raffa GM, Kowalewski M, Brodie D, Ogino M, Whitman G, Meani P, et al. Meta-Analysis of Peripheral or Central Extracorporeal Membrane Oxygenation in Postcardiotomy and Non-Postcardiotomy Shock. Ann Thorac Surg. 2019;107:311-321.
19. Lorusso R, Barili F, Di Mauro M, Schreiber C, Raffa GM, Makhoul M, et al. In-hospital neurologic complications in adult patients undergoing venoarterial extracorporeal membrane oxygenation: results from the extracorporeal life support organization registry. Crit Care Med. 2016;44:e964-e972.
20. Zangrillo A, Landoni G, Biondi-Zoccai G, Greco M, Greco T, Frati G, et al. A meta-analysis of complications and mortality of extracorporeal membrane oxygenation. Crit Care Resusc. 2013;15:172-178.
21. Russo JJ, Aleksova N, Pitcher I, Couture E, Parlow S, Faraz M, et al. Left ventricular unloading during extracorporeal membrane oxygenation in patients with cardiogenic shock. J Am Coll Cardiol. 2019;73:654-662.
22. Bernhardt AM, Potapov E, Schibilsky D, Hübler M, Friedrich M, Krabatsch T, et al. First in man evaluation of a novel circulatory support device: Early experience with the Impella 5.5 after CE mark approval in Germany. J Heart Lung Transplant. 2021;40:850-855.
23. Gonzalez MH, Acharya D, Lee S, Greenberg JW, Sinha SS, Mangi AA, et al. Improved survival after heart transplantation in patients bridged with extracorporeal membrane oxygenation in the new allocation system. J Heart Lung Transplant. 2021;40:149-157.
24. Chioncel O, Parissis J, Mebazaa A, Harjola VP, Coats AJS, Papp Z, et al. Epidemiology, pathophysiology and contemporary management of cardiogenic shock – A position statement from the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2020;22:1315-1341.
25. Khan SU, Khan MZ, Alkhouli M. Trends of Clinical Outcomes and Health Care Resource Use in Heart Failure in the United States. J Am Heart Assoc. 2020;9:e016782.
26. Moller JE, Engstrom T, Jensen LO, Schmidt H, Frandsen NJ, Andersen HR, et al. Microaxial Flow Pump or Standard Care in Infarct- Related Cardiogenic Shock. N Engl J Med. 2024;390:1382-1393.
27. Laghlam D, Benghanem S, Ortuno S, Arnaout M, Mongardon N, Tuil D, et al. Management of cardiogenic shock: A narrative review. Ann Intensive Care. 2024;14:45.

Publication of the article:

«Bulletin of problems biology and medicine», Issue 2,177, 18-25 pages, index UDC 616.12-008.46:616.127-005.8:616-005]-07-08

DOI:

10.29254/2077-4214-2025-2-177-18-25