• Laurent Bonello, Clement Delmas, Guillaume Schurtz, Guillaume Leurent, Eric Bonnefoy, Nadia Aissaoui, and Patrick Henry.
• Intensive Care Unit, Department of Cardiology, Hôpital Nord, AP-HM, 13015 Marseille, France; Inserm UMRS 1076, Aix-Marseille University, Mediterranean Academic Association for Research and Studies in Cardiology (MARS Cardio), 13385 Marseille, France. Electronic address: laurentbonello@yahoo.fr.
• Arch Cardiovasc Dis. 2018 Oct 1; 111 (10): 601-612.

AbstractCardiogenic shock (CS) is a major challenge in contemporary cardiology. Despite a better understanding of the pathophysiology of CS, its management has only improved slightly. The prevalence of CS has remained stable over the past decade, but its outcome has seen few improvements, with the 1-month mortality rate still in the range of 40-60%. Inotropes and vasopressors are the first-line therapies for CS, but they are associated with significant hazards, and have well-known deleterious effects. Furthermore, a significant number of patients develop refractory CS with haemodynamic instability, causing critical organ hypoperfusion and/or pulmonary congestion, despite increasing doses of catecholamines. A major change has resulted from the recent advent and availability of potent mechanical circulatory support (MCS) devices. These devices, which ensure sustained blood flow, provide a great and long-awaited opportunity to improve the prognosis of CS. Several efficient MCS devices are now available, including left ventricle-to-aorta circulatory support devices and full pulmonary and circulatory support with venoarterial extracorporeal membrane oxygenation. However, evidence to support their indications, the timing of implantation and the selection of patients and devices is scarce. Because these devices are gaining momentum and are becoming readily available, the "Unité de Soins Intensifs de Cardiologie" group of the French Society of Cardiology aims to propose practical algorithms for the use of these devices, to help intensive care unit and cardiac care unit physicians in this complex area, where evidence is limited.Copyright © 2018 Elsevier Masson SAS. All rights reserved.

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