Management of acute cardiogenic shock.

The present state of the art in mechanical cardiac assist technology has permitted application of machines to a variety of conditions that confound the cardiologist and cardiac surgeon alike. Decades of research and development have allowed the present devices to be used as bridges to native heart recovery and bridges to transplantation. We are now entering the era in which devices are being placed for permanent assist or replacement. Although the acute cardiogenic shock patient remains problematic, we now have at our disposable a variety of tools that have enabled us to salvage more patients than ever before. The experience with these systems continues to grow, with leading centers and investigators contributing meaningful information toward the application and development of the latest technologies. It has been said that mechanical therapies precede biological therapies. We are at the crossroads in which a combination of biological therapies with mechanical therapies is underway. Current research is investigating the role of mechanical cardiac support while biological therapies are introduced into the failing heart. In the meantime, the role of mechanical cardiac assist and replacement has matured into an effective means of treating acute cardiogenic shock of any variety.