Cardiogenic shock: old and new circulatory assist devices: the role of counter-pulsation 

Cardiogenic shock (CS) is a clinical condition still burdened with high mortality notwithstanding the advances in invasive and pharmacologic therapies. Apart from the well-established favourable prognostic impact of coronary revascularization for patients with CS after acute myocardial infarction, other ‘reference standards’ for treatment are lacking. The appropriate management of patients in CS is contingent on the underlying condition. Nonetheless, beside the condition behind the systolic or diastolic left ventricular dysfunction leading to inadequate oxygen delivery, the timely implementation of ventricular unloading, by improving peripheral perfusion and decreasing filling pressures, is an important tool to prevent irreversible organ damage. Present evidence downgraded intra-aortic balloon pump (IABP) as an effective tool for unloading patients with CS. This feedback is based on a single trial, addressing patients with acute coronary syndrome. In our centre, IABP has been utilized as an essential device for patients with acutely decompensated heart failure.

We retrospectively revised data from patients admitted to the Cardiac Intensive Care Unit at the ASST Grande Ospedale Metropolitano Niguarda Ca' Grande of Milan, during the period September 2014–December 2016. The diagnosis of CS was based on the criteria outlined by the Guidelines of the European Society of Cardiology (ESC): systolic blood pressure <90 mmHg or mean arterial pressure <60 mmHg, signs of increased central venous pressure (>12 mmHg), mental confusion, clammy and cold skin, mixed venous oxygen saturation <60%, arterial lactate >2 mmol/L, oliguria <0.5 mL/kg/h, and hepatorenal organ damage.