ECMO, Escalation Therapy, Patient Identification, AMI Cardiogenic Shock

European Heart Journal Supplements - Interview with Norman Mangner: Best Practices in Cardiogenic Shock


Prof Norman Mangner, MD, discusses the key messages in the European Heart Journal supplement “From Patient Selection to Escalation Strategies: Mechanical Circulatory Support in Cardiogenic Shock.” He is one of the lead authors of the publication. In his interview Prof. Mangner explains that the supplement provides a state-of-the-art overview of identification of cardiogenic shock patients in need of treatment with percutaneous mechanical circulatory support (MCS) devices. The topics in the chapters are:

  • Patient identification and selection – SCAI classification, sex-related differences, and phenotypes of cardiogenic shock
  • Basic principles of device selection – algorithms for selecting appropriate percutaneous ventricular assist devices (pVADs), implantation, and periprocedural best practices
  • Timing and treatment strategies – optimal timing for insertion of microaxial flow pumps (mAFPs), veno-arterial extracorporeal membrane oxygenation (VA ECMO), or ECMELLA (VA ECMO + Impella), acute myocardial infarction cardiogenic shock (AMICS) revascularization strategies, and shock networks
  • Patient management and monitoring – best practices for pVAD intensive care, including hemodynamic assessment, laboratory data, and imaging techniques
  • Escalation, de-escalation, and weaning strategies –de-escalation vs weaning, the rationale for specific strategies, device selection, patient management, and limitations
  • ECMELLA best practices – escalation to ECMELLA in cardiogenic shock, surgical transition to and protected weaning from ECMELLA, and ECMELLA clinical outlook
  • Glimpse into the future: current and upcoming evidence – results and challenges in cardiogenic shock trials

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