Percutaneous mechanical support in acute coronary syndromes

Abstract

Despite advances in interventional cardiology, persistently disappointing outcomes in patients with cardiogenic shock complicating myocardial infarction, together with the lack of evidence the that intra-aortic balloon pump improves outcomes in this patient population have led to a re-evaluation of other types of mechanical circulatory support. The increase in extracorporeal membrane oxygenation (ECMO) prompted by the H1N1 pandemic led to an increase in experience in using this technique in critically ill adult patients, and its use is now expanding in both respiratory and cardiac failure. Despite enthusiasm for the technique, high-quality evidence is lacking for its benefit. Nonetheless, ECMO and other types of percutaneous mechanical circulatory support do provide critical care clinicians with new supportive therapies that may prove to benefit patients, both from the high level of support that can be offered, and also minimising the use of potentially toxic inotropic agents.