Cardiogenic Shock Management in the Modern Era: A Narrative Review of Percutaneous Mechanical Circulatory Support Devices

Cardiogenic shock (CS) remains a significant clinical challenge with persistently high mortality rates. Defined by impaired cardiac output resulting in end-organ hypoperfusion, CS commonly arises from acute myocardial infarction (AMI-CS) or acute exacerbations of heart failure (HF-CS). The severity of CS is classified by the Society for Cardiovascular Angiography and Interventions (SCAI) into stages A (at risk) through E (extremis), which informs treatment strategies, including pharmacotherapy and mechanical circulatory support (MCS). Recent advancements in percutaneous mechanical circulatory support devices, including intra-aortic balloon pumps (IABPs), Impella devices, TandemHeart, Protek-Duo, and veno-arterial extracorporeal membrane oxygenation (VA-ECMO), have transformed management paradigms by offering targeted hemodynamic support. While DanGer-SHOCK, a pivotal randomized trial, demonstrated improved outcomes with early Impella use in anterior STEMI-associated CS, the trial's focus population and center expertise suggest that its findings should be interpreted in the context of broader AMI-CS and HF-CS presentations. Device selection is guided by shock severity, anatomical considerations, comorbidities, and institutional capabilities. This review synthesizes current evidence, evaluates the clinical utility and efficacy of existing and emerging percutaneous MCS technologies, and highlights ongoing clinical trials and future directions in optimizing CS management. Emphasis is placed on individualized patient selection, evidence-based deployment of MCS devices, and multidisciplinary team collaboration, which collectively represent a critical transition towards improving clinical outcomes in CS.