Difficult decisions in cardiothoracic surgery: Acute cardiogenic shock

Acute cardiogenic shock will often require surgical intervention by a cardiothoracic surgeon, especially when involving mechanical causes or complications. Initial treatment, however, typically involves less invasive approaches with a goal of cardiac support, and improving coronary blood flow while improving systemic perfusion. Although there has been a trend toward improved outcomes in patients who develop cardiogenic shock, mortality and morbidity rates still remain high and there is a need for improved treatment modalities. As such, many new devices have become available over the years to help manage this ongoing clinical problem. This chapter focuses on the treatment of cardiogenic shock and the current less-invasive devices that are used in the acute setting. It should be understood that regardless of the etiology, acute cardiogenic shock should be managed in a multidisciplinary approach.