ABSTRACT
When the native heart fails, mechanical blood pumps are deployed with the aim of restoring systemic and pulmonary blood ow as close as possible to physiological levels (Figure 12.1) Two broad categories of patients are eligible for support. In acute cardiogenic shock, temporary devices are used to salvage patients from imminent death, a number of which require careful assessment of cerebral injury following resuscitation.1 The majority in this category is considered to have potentially recoverable myocardial injury after myocardial infarction, myocarditis, or following failure to wean from cardiopulmonary bypass (CPB) during cardiac surgery. Should the heart not recover, the same devices are employed to sustain life pending deployment of a long-term blood pump or urgent cardiac transplantation. Because the usual outcomes in profound cardiogenic shock are mechanical
support or death, prospective randomised trials of circulatory assist versus continued medical management cannot be justi ed. Consequently, the evidence base for temporary mechanical support in cardiogenic shock emanates from observational studies, which document progressively improving clinical outcomes. Because circulatory support is expensive, each intervention requires a clearly de ned plan and outcome goal. Heroic but futile efforts to sustain life in the irretrievable or brain damaged patient are no longer acceptable.
