Mechanische Kreislaufunterstützung bei infarktbedingtem kardiogenem Schock

Der kardiogene Schock ist eine der Haupt-Todesursachen von Patienten mit einem akuten Koronarsyndrom (ACS). Mechanische Unterstützungssysteme werden zur Verbesserung der Hämodynamik eingesetzt, aber trotz des vielfältigen Einsatzes dieser Systeme gibt es wenig randomisierte Daten zur Effektivität und zum idealen Zeitpunkt der Implantation. Dieser Beitrag verschafft einen Überblick über die derzeitige Situation und zeigt die offenen Fragen auf.

Abstract

In acute myocardial infarction cardiogenic shock is still one of the most feared complications. Although medical and interventional treatment of myocardial infarction improved significantly over the last decades mortality of cardiogenic shock patients remains on unacceptable high levels with 30-day mortality rates of 40–50 %. To date only an early revascularization of the culprit infarct lesion is the only intervention with proven survival benefit for patients. Active mechanical assist devices were introduced more than two decades ago to support left ventricular function as addition to medical treatment with inotropes and vasopressors. Yet, to date only insufficient date exists for these devices in cardiogenic shock patients and therefore no general recommendation can be given. This viewpoint gives an overview about the most used devices. The different mechanism of left ventricular support will be explained, and the current evidence discussed. Furthermore, ongoing randomized controlled trials are highlighted.

Schlüsselwörter

Schock - Myokardinfarkt - mechanische Unterstützungssysteme - linksventrikuläre Unterstützungssysteme

Key words

cardiogenic shock - myocardial infarction - mechanical assist devices - left ventricular support

Publication History

Article published online:
07 September 2022

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