2025 HFSA Contemporary Issues in Heart Failure - OnDemand-Device Selection in AMI and Non-AMI Cardiogenic Shock

Video Transcription

Video Summary

Dr. Shashank Sinha presented on device selection in acute myocardial infarction (AMI) and non-AMI cardiogenic shock, emphasizing the heterogeneous, multifactorial nature of shock that leads to multi-organ dysfunction. Key points included the importance of early recognition, staging shock severity using the SCAI classification (A through E), and utilizing invasive hemodynamics for better outcomes. Timely initiation of temporary mechanical support, particularly micro-axial flow pumps, has shown mortality benefits in select patients per the DANGER shock trial, whereas intra-aortic balloon pumps and VA ECMO have limited survival benefit. Multidisciplinary shock teams and standardized approaches improve care and survival. Continuous reassessment and addressing end-organ perfusion are critical, as complications from devices and shock itself are common and must be managed carefully. Incorporating palliative care and advanced therapies like LVAD or transplantation should follow early assessment. Overall, a team-based, protocolized strategy focusing on personalized device selection and comprehensive management optimizes outcomes in cardiogenic shock.

Keywords

acute myocardial infarction

cardiogenic shock

SCAI classification

mechanical circulatory support

micro-axial flow pumps

multidisciplinary shock teams