Mechanical circulatory support (MCS) devices are effective tools in managing refractory cardiogenic shock (CS). Data comparing veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and IMPELLA^® are however scarce. We aimed to assess outcomes of patients implanted with these two devices and eligible to both systems. From 2004 to 2020, we retrospectively analyzed 128 patients who underwent VA-ECMO or IMPELLA^® in our institution for refractory left ventricle (LV) dominant CS. All patients were eligible to both systems: 97 patients were first implanted with VA-ECMO and 31 with IMPELLA^®. The primary endpoint was 30-day all-cause death. VA-ECMO patients were younger (52 vs. 59.4, p = 0.006) and had a higher lactate level at baseline than those in the IMPELLA^® group (6.84 vs. 3.03 mmol/L, p < 0.001). Duration of MCS was similar between groups (9.4 days vs. 6 days in the VA-ECMO and IMPELLA^® groups respectively, p = 0.077). In unadjusted analysis, no significant difference was observed between groups in 30-day mortality: 43.3% vs. 58.1% in the VA-ECMO and IMPELLA^® groups, respectively (p = 0.152). After adjustment, VA-ECMO was associated with a significant reduction in 30-day mortality (HR = 0.25, p = 0.004). A higher rate of MCS escalation was observed in the IMPELLA^® group: 32.3% vs. 10.3% (p = 0.003). In patients eligible to either VA-ECMO or IMPELLA^® for LV dominant refractory CS, VA-ECMO was associated with improved survival rate and a lower need for escalation.

Electrical storm (ES) with refractory cardiogenic shock carries high mortality. While veno-arterial extracorporeal membrane oxygenation (V-A ECMO) may stab

Purpose of review: To examine the role of echocardiography in managing patients with refractory cardiogenic shock supported by temporary mechanical circulatory support (t-MCS) and provide practical recommendations to improve clinical practice. Recent findings: t-MCS devices are increasingly used to stabilize patients with refractory cardiogenic shock. Echocardiography, due to its accessibility and ability to assess both structural and functional aspects of heart failure, is ideally suited for daily bedside evaluation of cardiac function and t-MCS-myocardial interactions. Summary: From t-MCS initiation to liberation, echocardiography is essential to guide clinical decision-making. It aids in selecting the most appropriate t-MCS device, ensuring optimal positioning, and fine-tuning flow parameters in real-time based on native cardiac function and patient needs. Additionally, echocardiography is critical for identifying intracardiac complications and directing unloading strategies in venoarterial extracorporeal membrane oxygenation, particularly with very low residual ejection or aortic valve closure. Finally, the weaning process should be informed by comprehensive echocardiographic evaluations, aligned with international guidelines. These steps are outlined in this review, accompanied by clear and practical recommendations to enhance clinical practice.