# Mechanical circulatory support in cardiogenic shock: a contemporary head-to-head comparison

## TL;DR

This paper compares modern mechanical circulatory support devices used in cardiogenic shock to guide optimal patient care.

## Contribution

The paper provides a head-to-head comparison of mechanical circulatory support devices and proposes translatable algorithms for their use.

## Key findings

- A comparison of IABP, Impella, and ECLS devices is presented.
- Device selection and operation algorithms are proposed for managing cardiogenic shock.
- Current protocols for escalation, de-escalation, and antithrombotic use are reviewed.

## Abstract

Modern technology has expanded the armamentarium of temporary mechanical circulatory support devices implemented for hemodynamic stabilization of patients in cardiogenic shock. The predominately used ones are intra-aortic balloon pump (IABP), Impella devices, and extracorporeal life support (ECLS) circuits. They are transcutaneous or surgically implanted, utilized for up to 30 days and can either assist or totally replace cardiac function, providing time for myocardial healing (bridge to recovery) or treatment escalation (bridge to destination therapy, bridge to transplantation). In light of the recently published joint consensus of the Perioperative Quality Initiative and Enhanced Recovery After Surgery Cardiac Society on temporary mechanical circulatory support, purpose of the current review is to provide a succinct head-to-head comparison of widely available devices, as well as current escalation, de-escalation and antithrombotic protocols; thus, it proposes immediately translatable device selection and operation algorithms to medical professionals for optimal patient care and effective management of cardiogenic shock.

The online version contains supplementary material available at 10.1007/s10741-026-10612-8.