Temporary Mechanical Circulatory Support for Acute Myocardial Infarction Cardiogenic Shock

Saliha Erdem; Dhruvil Ashishkumar Patel; Karl Abou Zeid; Joe Aoun

doi:10.14797/mdcvj.1654

Temporary Mechanical Circulatory Support for Acute Myocardial Infarction Cardiogenic Shock

Methodist DeBakey Cardiovascular Journal

Volume 21 (2025): Issue 4

By: Saliha Erdem , Dhruvil Ashishkumar Patel , Karl Abou Zeid and Joe Aoun

Open Access

|Oct 2025

Abstract

Cardiogenic shock (CS) complicating acute myocardial infarction (AMI) remains a critical clinical challenge associated with high morbidity and mortality. Temporary mechanical circulatory support (tMCS) devices can stabilize hemodynamics, improve cardiac output, and enhance survival, thereby continuing to be more favorable with operators. This review summarizes the pathophysiology of AMI-CS and examines the evidence informing recommendations for tMCS device implementation—specifically the intra-aortic balloon pump, Impella (Abiomed/J&J MedTech), TandemHeart™ (LivaNova, Inc.), and venoarterial extracorporeal membrane oxygenation—with a particular focus on clinical trial data and recent guideline recommendations to assist operators in implementing decision-making.

References

Jacobs AK, Leopold JA, Bates E, et al. Cardiogenic shock caused by right ventricular infarction: a report from the SHOCK registry. J Am Coll Cardiol. 2003 Apr 16;41(8):1273-9. doi: 10.1016/s0735-1097(03)00120-7
Open DOI Search in Google Scholar Back to article
Hochman JS. Cardiogenic shock complicating acute myocardial infarction: expanding the paradigm. Circulation. 2003 Jun 24;107(24):2998-3002. doi: 10.1161/01.CIR.0000075927.67673.F2
Open DOI Search in Google Scholar Back to article
Nakata J, Yamamoto T, Saku K, Ikeda Y, Unoki T, Asai K. Mechanical circulatory support in cardiogenic shock. J Intensive Care. 2023 Dec 19;11(1):64. doi: 10.1186/s40560-023-00710-2
Open DOI Search in Google Scholar Back to article
Werdan K, Gielen S, Ebelt H, Hochman JS. Mechanical circulatory support in cardiogenic shock. Eur Heart J. 2014 Jan;35(3):156-67. doi: 10.1093/eurheartj/eht248
Open DOI Search in Google Scholar Back to article
Thiele H, Sick P, Boudriot E, et al. Randomized comparison of intra-aortic balloon support with a percutaneous left ventricular assist device in patients with revascularized acute myocardial infarction complicated by cardiogenic shock. Eur Heart J. 2005 Jul;26(13):1276-83. doi: 10.1093/eurheartj/ehi161
Open DOI Search in Google Scholar Back to article
Greulich S, Mayr A, Gloekler S, et al. Time-Dependent Myocardial Necrosis in Patients With ST-Segment-Elevation Myocardial Infarction Without Angiographic Collateral Flow Visualized by Cardiac Magnetic Resonance Imaging: Results From the Multicenter STEMI-SCAR Project. J Am Heart Assoc. 2019 Jun 18;8(12):e012429. doi: 10.1161/JAHA.119.012429
Open DOI Search in Google Scholar Back to article
Basir MB, Lemor A, Gorgis S, et al. Early Utilization of Mechanical Circulatory Support in Acute Myocardial Infarction Complicated by Cardiogenic Shock: The National Cardiogenic Shock Initiative. J Am Heart Assoc. 2023 Dec 5;12(23):e031401. doi: 10.1161/JAHA.123.031401
Open DOI Search in Google Scholar Back to article
Berg DD, Bohula EA, Patel SM, et al. Epidemiology of cardiogenic shock using the Shock Academic Research Consortium (SHARC) consensus definitions. Eur Heart J Acute Cardiovasc Care. 2024 Oct 28;13(10):709-714. doi: 10.1093/ehjacc/zuae098
Open DOI Search in Google Scholar Back to article
Strom JB, Zhao Y, Shen C, et al. National trends, predictors of use, and in-hospital outcomes in mechanical circulatory support for cardiogenic shock. EuroIntervention. 2018 Apr 6;13(18):e2152-e2159. doi: 10.4244/EIJ-D-17-00947
Open DOI Search in Google Scholar Back to article
Panhwar MS, Gupta T, Karim A, et al. Trends in the Use of Short-Term Mechanical Circulatory Support in the United States – An Analysis of the 2012 – 2015. National Inpatient Sample. Structural Heart. 2019 Dec;3(6):499-506. doi: 10.1080/24748706.2019.1669234
Open DOI Search in Google Scholar Back to article
Lund GK, Stork A, Muellerleile K, et al. Prediction of left ventricular remodeling and analysis of infarct resorption in patients with reperfused myocardial infarcts by using contrast-enhanced MR imaging. Radiology. 2007 Oct;245(1):95-102. doi: 10.1148/radiol.2451061219
Open DOI Search in Google Scholar Back to article
Rao SV, O’Donoghue ML, Ruel M, et al. 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes. A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation; 2025 Apr;151(13):e771-e862. doi: 10.1161/CIR.0000000000001309
Open DOI Search in Google Scholar Back to article
Dharmakumar R, Kloner RA, Fishbein M, et al. Reperfused Myocardial Infarction. JACC: Adv. 2025 Feb;4(2):101528. doi: 10.1016/j.jacadv.2024.101528
Open DOI Search in Google Scholar Back to article
van Diepen S, Katz JN, Albert NM, et al. Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association. Circulation. 2017 Oct 17;136(16):e232-e268. doi: 10.1161/CIR.0000000000000525
Open DOI Search in Google Scholar Back to article
Rab T, Ratanapo S, Kern KB, et al. Cardiac Shock Care Centers: JACC Review Topic of the Week. J Am Coll Cardiol. 2018 Oct 16;72(16):1972-1980. doi: 10.1016/j.jacc.2018.07.074
Open DOI Search in Google Scholar Back to article
Vahdatpour C, Collins D, Goldberg S. Cardiogenic Shock. J Am Heart Assoc. 2019 Apr 16;8(8):e011991. doi: 10.1161/JAHA.119.011991
Open DOI Search in Google Scholar Back to article
Tehrani BN, Truesdell AG, Psotka MA, et al. A Standardized and Comprehensive Approach to the Management of Cardiogenic Shock. JACC Heart Fail. 2020 Nov;8(11):879-891. doi: 10.1016/j.jchf.2020.09.005
Open DOI Search in Google Scholar Back to article
Christenson JT, Simonet F, Badel P, Schmuziger M. Evaluation of preoperative intra-aortic balloon pump support in high risk coronary patients. Eur J Cardiothorac Surg. 1997 Jun;11(6):1097-103; discussion 1104. doi: 10.1016/s1010-7940(97)00087-0
Open DOI Search in Google Scholar Back to article
Ryan TJ, Antman EM, Brooks NH, et al. 1999 update: ACC/AHA guidelines for the management of patients with acute myocardial infarction; A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infarction). J Am Coll Cardiol. 1999 Sep;34(3):890-911k. doi: 10.1016/s0735-1097(99)00351-4
Open DOI Search in Google Scholar Back to article
Hochman JS, Sleeper LA, Webb JG, et al. Early Revascularization in Acute Myocardial Infarction Complicated by Cardiogenic Shock. New Engl J Med. 1999 Aug 26;341(9):625-634. doi: 10.1056/NEJM199908263410901
Open DOI Search in Google Scholar Back to article
Gillespie LE, Lane BH, Shaw CR, et al. The Intra-aortic Balloon Pump: A Focused Review of Physiology, Transport Logistics, Mechanics, and Complications. J Society Cardiovasc Angiog Interv. 2024 Feb 18;3(5):101337. doi: 10.1016/j.jscai.2024.101337
Open DOI Search in Google Scholar Back to article
Huckaby LV, Seese LM, Mathier MA, Hickey GW, Kilic A. Intra-Aortic Balloon Pump Bridging to Heart Transplantation. Circ Heart Fail. 2020 Aug;13(8):e006971. doi: 10.1161/CIRCHEARTFAILURE.120.006971
Open DOI Search in Google Scholar Back to article
Thiele H, Zeymer U, Neumann FJ, et al. Intra-aortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock (IABP-SHOCK II): final 12 month results of a randomised, open-label trial. Lancet. 2013 Nov 16;382(9905):1638-45. doi: 10.1016/S0140-6736(13)61783-3
Open DOI Search in Google Scholar Back to article
Bhimaraj A, Garan AR, Kanwar MK. Pitfalls in the World of Evidence-Based Medicine: Should IABP Be en-DANGER-ed by the DanGer Shock Trial? Circ Heart Fail. 2024 Dec;17(12):e012077. doi: 10.1161/CIRCHEARTFAILURE.124.012077
Open DOI Search in Google Scholar Back to article
Masiero G, et al. Mechanical Circulatory Support with Impella: Principles, Evidence, and Daily Practice. J Clin Med. 2024 Aug 6;13(16):4586. doi: 10.3390/jcm13164586
Open DOI Search in Google Scholar Back to article
Watanabe S, Fish K, Kovacic JC, et al. Left Ventricular Unloading Using an Impella CP Improves Coronary Flow and Infarct Zone Perfusion in Ischemic Heart Failure. J Am Heart Assoc. 2018 Mar 7;7(6):e006462. doi: 10.1161/JAHA.117.006462
Open DOI Search in Google Scholar Back to article
Cubeddu RJ, Lago R, Horvath SA, Vignola PA, O’Neill W, Palacios IF. Use of the Impella 25 system alone, after and in combination with an intra-aortic balloon pump in patients with cardiogenic shock: case description and review of the literature. EuroIntervention. 2012 Apr;7(12):1453-1460. doi: 10.4244/EIJV7I12A226
Open DOI Search in Google Scholar Back to article
Glazier JJ, Kaki A. The Impella Device: Historical Background, Clinical Applications and Future Directions. Int J Angiol. 2019 Jun;28(2):118-123. doi: 10.1055/s-0038-1676369
Open DOI Search in Google Scholar Back to article
Zein R, Patel C, Mercado-Alamo A, Schreiber T, Kaki A. A Review of the Impella Devices. Interv Cardiol. 2022 Apr 8;17:e05. doi: 10.15420/icr.2021.11
Open DOI Search in Google Scholar Back to article
Kim Y, Shapero K, Ahn SS, Goldsweig AM, Desai N, Altin SE. Outcomes of mechanical circulatory support for acute myocardial infarction complicated by cardiogenic shock. Cath Cardiovasc Interv. 2022 Feb;99(3):658-663. doi: 10.1002/ccd.29834
Open DOI Search in Google Scholar Back to article
Almarzooq ZI, Li S, Song Y, Secemsky EA, Pinto DS, Yeh RW. Are There Disparities in the Utilization of the Impella Device in Acute Myocardial Infarction and Cardiogenic Shock in the United States? J Soc Cardiovasc Angiog Interv. 2024 Apr 2;3(4):101336. doi: 10.1016/j.jscai.2024.101336
Open DOI Search in Google Scholar Back to article
Lim HS, Gonzalez-Costello J, Belohlavek J, et al. Hemodynamic management of cardiogenic shock in the intensive care unit. J Heart Lung Transplant. 2024 Jul;43(7):1059-1073. doi: 10.1016/j.healun.2024.03.009
Open DOI Search in Google Scholar Back to article
Seyfarth M, Sibbing D, Bauer I, et al. A Randomized Clinical Trial to Evaluate the Safety and Efficacy of a Percutaneous Left Ventricular Assist Device Versus Intra-Aortic Balloon Pumping for Treatment of Cardiogenic Shock Caused by Myocardial Infarction. J Am Coll Cardiol. 2008 Nov 4;52(19):1584-1588. doi: 10.1016/j.jacc.2008.05.065
Open DOI Search in Google Scholar Back to article
Basir MB, Lemor A, Gorgis S, et al. Early Utilization of Mechanical Circulatory Support in Acute Myocardial Infarction Complicated by Cardiogenic Shock: The National Cardiogenic Shock Initiative. J Am Heart Assoc. 2023 Dec 5;12(23):e031401. doi: 10.1161/JAHA.123.031401
Open DOI Search in Google Scholar Back to article
Ouweneel DM, Eriksen E, Sjauw KD, et al. Percutaneous Mechanical Circulatory Support Versus Intra-Aortic Balloon Pump in Cardiogenic Shock After Acute Myocardial Infarction. J Am Coll Cardiol. 2017 Jan 24;69(3):278-287. doi: 10.1016/j.jacc.2016.10.022
Open DOI Search in Google Scholar Back to article
Møller JE, Engstrom T, Jensen LO, et al. Microaxial Flow Pump or Standard Care in Infarct-Related Cardiogenic Shockk. New Engl J Med. 2024 Apr 18;390(15):1382-1393. doi: 10.1056/NEJMoa2312572
Open DOI Search in Google Scholar Back to article
Zweck E, Hassager C, Beske RP, et al. Microaxial Flow Pump Use and Renal Outcomes in Infarct-Related Cardiogenic Shock: A Secondary Analysis of the DanGer Shock Trial. Circulation. 2024 Dec 17;150(25):1990-2003. doi: 10.1161/CIRCULATIONAHA.124.072370
Open DOI Search in Google Scholar Back to article
Khan MH, Corbett BJ, Hollenberg SM. Mechanical circulatory support in acute cardiogenic shock. F1000Prime Rep. 2014 Oct 1;6:91. doi: 10.12703/P6-91
Open DOI Search in Google Scholar Back to article
Burkhoff D, Sayer G, Doshi D, Uriel N. Hemodynamics of Mechanical Circulatory Support. J Am Coll Cardiol. 2015 Dec 15;66(23):2663-2674. doi: 10.1016/j.jacc.2015.10.017
Open DOI Search in Google Scholar Back to article
Burkhoff D, Cohen H, Brunckhorst C, O’Neill WW; TandemHeart Investigators Group. A randomized multicenter clinical study to evaluate the safety and efficacy of the TandemHeart percutaneous ventricular assist device versus conventional therapy with intraaortic balloon pumping for treatment of cardiogenic shock. Am Heart J. 2006 Sep;152(3):469e1-8. doi: 10.1016/j.ahj.2006.05.031
Open DOI Search in Google Scholar Back to article
Kar B, Gregoric ID, Basra SS, Idelchik GM, Loyalka P. The percutaneous ventricular assist device in severe refractory cardiogenic shock. J Am Coll Cardiol. 2011 Feb 8;57(6):688-96. doi: 10.1016/j.jacc.2010.08.613
Open DOI Search in Google Scholar Back to article
Kar B, Adkins LE, Civitello AB, et al. Clinical experience with the TandemHeart percutaneous ventricular assist device. Tex Heart Inst J. 2006;33(2):111-5. PMID: 16878609.
Search in Google Scholar Back to article
Cheng JM, den Uil CA, Hoeks SE, et al. Percutaneous left ventricular assist devices vs intra-aortic balloon pump counterpulsation for treatment of cardiogenic shock: a meta-analysis of controlled trials. Eur Heart J. 2009 Sep;30(17):2102-8. doi: 10.1093/eurheartj/ehp292
Open DOI Search in Google Scholar Back to article
Gregoric ID, Kar B, Mesar T, et al. Perioperative use of TandemHeart percutaneous ventricular assist device in surgical repair of postinfarction ventricular septal defect. ASAIO J. 2014 Sep-Oct;60(5):529-32. doi: 10.1097/MAT.0000000000000108
Open DOI Search in Google Scholar Back to article
Rao P, Khalpey Z, Smith R, Burkhoff D, Kociol RD. Venoarterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock and Cardiac Arrest. Circ Heart Fail. 2018 Sep;11(9):e004905. doi: 10.1161/CIRCHEARTFAILURE.118.004905
Open DOI Search in Google Scholar Back to article
Biscotti M, Bacchetta M. The “sport model”: extracorporeal membrane oxygenation using the subclavian artery. Ann Thorac Surg. 2014 Oct;98(4):1487-9. doi: 10.1016/j.athoracsur.2014.02.069
Open DOI Search in Google Scholar Back to article
Vallabhajosyula S, O’Horo JC, Antharam P, et al. Venoarterial Extracorporeal Membrane Oxygenation With Concomitant Impella Versus Venoarterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock. ASAIO J. 2020 May;66(5):497-503. doi: 10.1097/MAT.0000000000001039
Open DOI Search in Google Scholar Back to article
Zavalichi MA, Nistor I, Nedelcu AE, et al. Extracorporeal Membrane Oxygenation in Cardiogenic Shock due to Acute Myocardial Infarction: A Systematic Review. Biomed Res Int. 2020 Apr 19;2020:6126534. doi: 10.1155/2020/6126534
Open DOI Search in Google Scholar Back to article
Sheu JJ, Tsai TH, Lee FY, et al. Early extracorporeal membrane oxygenator-assisted primary percutaneous coronary intervention improved 30-day clinical outcomes in patients with ST-segment elevation myocardial infarction complicated with profound cardiogenic shock. Crit Care Med. 2010 Sep;38(9):1810-7. doi: 10.1097/CCM.0b013e3181e8acf7
Open DOI Search in Google Scholar Back to article
Rao P, Alouidor B, Smith R, Khalpey Z. Ambulatory central VA-ECMO with biventricular decompression for acute cardiogenic shock. Catheter Cardiovasc Interv. 2018 Nov 1;92(5):1002-1004. doi: 10.1002/ccd.27428
Open DOI Search in Google Scholar Back to article
Brunner S, Guenther SPW, Lackermair K, et al. Extracorporeal Life Support in Cardiogenic Shock Complicating Acute Myocardial Infarction. J Am Coll Cardiol. 2019 May 14;73(18):2355-2357. doi: 10.1016/j.jacc.2019.02.044
Open DOI Search in Google Scholar Back to article
Ostadal P, Rokyta R, Karasek J, et al. Extracorporeal Membrane Oxygenation in the Therapy of Cardiogenic Shock: Results of the ECMO-CS Randomized Clinical Trial. Circulation. 2023 Feb 7;147(6):454-464. doi: 10.1161/CIRCULATIONAHA.122.062949
Open DOI Search in Google Scholar Back to article
Banning AS, Sabate M, Orban M, et al. Venoarterial extracorporeal membrane oxygenation or standard care in patients with cardiogenic shock complicating acute myocardial infarction: the multicentre, randomised EURO SHOCK trial. EuroIntervention. 2023 Aug 21;19(6):482-492. doi: 10.4244/EIJ-D-23-00204
Open DOI Search in Google Scholar Back to article
Thiele H, Zeymer U, Akin I, et al. Extracorporeal Life Support in Infarct-Related Cardiogenic Shock. N Engl J Med. 2023 Oct 5;389(14):1286-1297. doi: 10.1056/NEJMoa2307227
Open DOI Search in Google Scholar Back to article
Zeymer U, Freund A, Hochadel M, et al. Venoarterial extracorporeal membrane oxygenation in patients with infarct-related cardiogenic shock: an individual patient data meta-analysis of randomised trials. Lancet. 2023 Oct 14;402(10410):1338-1346. doi: 10.1016/S0140-6736(23)01607-0
Open DOI Search in Google Scholar Back to article
Zeymer U, Freund A, Hochadel M, et al. Do DanGer-SHOCK-like patients benefit from VA-ECMO treatment in infarct-related cardiogenic shock? results of an individual patient data meta-analysis. Eur Heart J Acute Cardiovasc Care. 2024 Sep 25;13(9):658-661. doi: 10.1093/ehjacc/zuae093
Open DOI Search in Google Scholar Back to article
Byrne RA, Rossello X, Coughlan JJ, et al. 2023 ESC Guidelines for the management of acute coronary syndromes: Developed by the task force on the management of acute coronary syndromes of the European Society of Cardiology (ESC). Eur Heart J. 2023 Oct 12;44(38):3720-3826. doi: 10.1093/eurheartj/ehad191
Open DOI Search in Google Scholar Back to article

Articles in this issue

DOI: https://doi.org/10.14797/mdcvj.1654 | Journal eISSN: 1947-6108

Journal RSS Feed

Language: English

Page range: 14 - 25

Submitted on: Jun 13, 2025

Accepted on: Jul 16, 2025

Published on: Oct 1, 2025

Published by: Houston Methodist DeBakey Heart & Vascular Center

In partnership with: Paradigm Publishing Services

Keywords:

myocardial infarction,

cardiogenic shock,

MCS,

acute coronary syndrome,

shock

© 2025 Saliha Erdem, Dhruvil Ashishkumar Patel, Karl Abou Zeid, Joe Aoun, published by Houston Methodist DeBakey Heart & Vascular Center
This work is licensed under the Creative Commons Attribution-NonCommercial 4.0 License.

Volume 21 (2025): Issue 4