© RADCLIFFE CARDIOLOGY 2020 Acute Heart Failure Access at: www.CFRjournal.com Cardiogenic shock (CS) is a circulatory failure as a consequence of left, right or biventricular dysfunction. 1 It leads to critical end-organ hypoperfusion due to primary cardiac dysfunction. 1 Therefore, CS is not only a cardiac disease but also a multiorgan dysfunction syndrome involving the entire circulatory system, often complicated by a systemic inflammatory response syndrome. 2 The goals of haemodynamic support for patients with CS should be circulatory support, ventricular unloading/support, coronary arteries perfusion and decongestion. 3 Unfortunately, pharmacological approaches fail to achieve all the objectives. 3 Often drug therapy will solve only one element, but this is at the cost of another. 3 For example, although vasopressors sustain haemodynamic status by increasing mean arterial pressure, their use can impair microvascular organ perfusion, increase left ventricular afterload and myocardial work and cause myocardial ischaemia. 3 Therefore, in recent decades, more aggressive strategies, such as temporary mechanical circulatory support (TCS), have been investigated to address all the elements to achieve an optimal haemodynamic status. TCS includes a group of devices used generally for less than 30 days to maintain adequate organ perfusion (Table 1). 4 TCS counteracts acute circulatory failure, which might also arise after cardiac surgery. 4 Moreover, since it was introduced, TCS has been used as a bridge to a more definitive therapy. 5 The management of CS with TCS has advanced in the past decade. 5 The scope of applications has widened, and easily deployable devices are significantly more available. 5 High-risk procedures, for example, percutaneous coronary interventions (PCI) and ventricular tachycardia ablation, have also started to involve TCS device use. 5 However, indications for TCS and device selection are part of a complex process requiring consideration of the severity of CS, early and prompt haemodynamic resuscitation, specific patient risk factors, technical limitations, adequate resources and training and assessment of the futility of care. 6 Early intervention with the most appropriate mechanical circulatory support device may improve outcomes. 6 The aim of this review is to provide an overview of the TCS devices currently available for patients with CS. Temporary Mechanical Circulatory Support Devices The technical features of percutaneous assist devices available are compared in Table 2. Intra-aortic Balloon Pump The intra-aortic balloon pump (IABP) is the most frequently used form of TCS (Figure 1A). 7 Straightforward insertion, ready availability and low Abstract Cardiogenic shock (CS) is a challenging syndrome, associated with significant morbidity and mortality. Although pharmacological therapies are successful and can successfully control this acute cardiac illness, some patients remain refractory to drugs. Therefore, a more aggressive treatment strategy is needed. Temporary mechanical circulatory support (TCS) can be used to stabilise patients with decompensated heart failure. In the last two decades, the increased use of TCS has led to several kinds of devices becoming available. However, indications for TCS and device selection are part of a complex process. It is necessary to evaluate the severity of CS, any early and prompt haemodynamic resuscitation, prior TCS, specific patient risk factors, technical limitations and adequacy of resources and training, as well as an assessment of whether care would be futile. This article examines options for commonly used TCS devices, including intra-aortic balloon pumps, a pulsatile percutaneous ventricular assist device (the iVAC), veno-arterial extra-corporeal membrane oxygenation and Impella (Abiomed) and TandemHeart (LivaNova) percutaneous ventricular assist device. Keywords Temporary mechanical circulation, intra-aortic balloon pump, left ventricular assist device, extra-corporeal membrane oxygenation, acute heart failure Disclosure: The authors have no conflicts of interest to declare. Received: 19 June 2019 Accepted: 27 September 2019 Citation: Cardiac Failure Review 2020;6:e01. DOI: https://doi.org/10.15420/cfr.2019.02 Correspondence: Roberto Lorusso, Cardiothoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, P Debeylaan 26, Maastricht 6220 AZ, the Netherlands. E: roberto.lorusso@mumc.nl Open Access: This work is open access under the CC-BY-NC 4.0 License which allows users to copy, redistribute and make derivative works for non- commercial purposes, provided the original work is cited correctly. Temporary Mechanical Circulatory Support in Acute Heart Failure Federica Jiritano, 1,2 Valeria Lo Coco, 1 Matteo Matteucci, 1,3 Dario Fina, 1,4 Anne Willers 1 and Roberto Lorusso 1 1. Cardiothoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands; 2. Cardiac Surgery Unit, University Magna Graecia of Catanzaro, Catanzaro, Italy; 3. Department of Cardiac Surgery, Circolo Hospital, University of Insubria, Varese, Italy; 4. University of Milan, IRCCS Policlinico San Donato, Milan, Italy