Pulsatile ECMO: The Future of Mechanical Circulatory Support for Severe Cardiogenic Shock

Vincent DE, Moazami N, D'Alessandro D, Fraser JF, Heinsar S, Roche ET, Ayers BC, Singh M, Langer N, Deshpande SR, Jaquiss RDB, Fukamachi K, Rabi SA, Osho A, Kuroda T, Karimov JH, Miyamoto T, Sethu P, Giridharan GA, Kvernebo K, Copland J JACC Basic Transl. Sci. DOI 10.1016/j.jacbts.2024.02.015

Abstract: The utilization of temporary mechanical circulatory support (tMCS) has increased significantly over the last 40 years for stabilization of salvageable patients; however, there has not been much improvement in survival when used for cardiogenic shock, which has a current mortality of around 50%. Many efforts have been devoted to better understanding the stages of cardiogenic shock, as well as how combinations of both drugs and devices can increasingly be used to strive for recovery of the native heart. Despite the clear and urgent need for improving outcomes, none of the clinical trials has found convincing evidence for a survival advantage using tMCS compared with other forms of care. Therefore, new approaches to understanding the pathophysiology of cardiogenic shock, as well as novel technologies, would be beneficial.