Revisiting October’s Insights: Cardiogenic Shock Centres – the way to success

Marek Gierlotka:    We try to select in which patients we want to use MCS. We have some ideas, but these ideas are not clear enough for us now to have this 15 or 25% of patients selected. We do not know how to select them in the best way, who really survive on MCS. Generally, we use IMPELLA for lower stages of cardiogenic shock and ECMO for higher stages of cardiogenic shock. We use hemodynamic parameters mainly to decide that we go on MCS; it’s a cardiac index, cardiac power output, PAPi, and so on. We finally go to the results of the trials: older trials or the new trials. Even if we feel that we have to use MCS, the trials are mainly neutral. We do not have a clear advantage of IMPELLA over balloon. And some ideas are, and we believe that we should use MCS as quickly as we can, so in the guidelines, we recently have MCS before revascularization. We also know that it is probably the best way. However, during the trials, during gathering our knowledge on using MCS, we still have the neutral results of the last trials, with two trials with ECMO. So, even if we use ECMO in all patients as quickly as we can use it, or we use it only for patients deteriorating on classic treatment with pressors, we do not have an advantage in survival.