Kardiologie up2date 2014; 10(02): 103-109
DOI: 10.1055/s-0034-1365734
Kardiovaskuläre Notfälle
© Georg Thieme Verlag KG Stuttgart · New York

Mechanische Kreislaufunterstützungssysteme im kardiogenen Schock

Marcus Hennersdorf
,
J. Graf
,
I. Häger
,
M. Ferrari
Further Information

Publication History

Publication Date:
28 July 2014 (online)

Abstract

Cardiogenic shock represents a situation with inadequate tissue perfusion resulting from cardiac dysfunction, mostly caused by myocardial infarction. The mortality rate persists on a high level and can be decreased by acute revascularization. In cases with persisting shock despite optimal medical therapy including balanced catecholamine/ volume-therapy and development of a multiorgandysfunction-syndrome (MODS), the use of extracorporal assist devices may lead to a stabilization of the hemodynamic state. The implantation of an intraaortic balloon counterpulsation is not more recommended, since the IABP-Shock-II trial has been published. Actually, there are three possibilities of percutaneous assist systems: TandemHeart, Impella-Recover and extracorporal membrane oxygenation (ECMO). All of these systems lead to a hemodynamic improvement. However, a reduction of the mortality rate has only been shown in small trials. Parameters of better outcome following ECLS-therapy are the initial pH and lactate-concentration, the duration of CPR before implantation and the development of a MODS, as well as the rate of device-related complications. Randomized trials are needed to corroborate the benefit of the use of these systems.