Acute Heart Failure and Cardiogenic Shock - Significance of ECLS

Cardiogenic shock (CS) represents the most serious course of acute heart failure (AHF) with mortality rates of up to 50%. Temporary mechanical circulatory support (MCS) provides a valuable treatment option in refractory CS. Particularly extracorporal life support (ECLS) represents a more and more frequently deployed device in this context. Although increasingly used for CS management, no high level evidence for a cardiovascular benefit of ECLS exists today. Based on these limitations, a critical review of risks and benefits on an individual patient level including hemodynamic and clinical characteristics is mandatory to avoid futile situations. Current practice guidelines recommend establishment of dedicated CS-centers with structured therapeutic workflows applied by a well trained ECLS-team. In this article fundamental concepts of pathophysiology in the context of AHF and CS are reviewed and the significance of ECLS for this indication is discussed.