Mechanical circulatory support in CS: device or patient?

> Without data, you're just another person with an opinion. > > W. Edwards Deming Cardiogenic shock (CS) is an evolving syndrome due to pump failure and ensuing hypoperfusion as landmark points of the downward spiral leading to multiorgan failure. Among many challenges that need to be addressed, two main critical issues have been coming into focus over the past years: the need for an optimum (early) timing of treatment and a full understanding of an array of ‘CS phenotypes’, requiring tailored therapies. Indeed, the same cardiac insult, acting on top of pre-existing cardiac or systemic disease, can activate different mechanistic drivers yielding to the formation of distinct shock states.1 Whenever is the cause leading to CS, a great emphasis has been recently paid to the protective role of the early mechanical circulatory support (MCS) implantation for stage C–E CS or preceding the revascularisation in patients with acute myocardial infarction (AMI).2 There is no strong evidence as yet regarding better safety and outcome among different percutaneous ventricular-assist devices.3 4 The only, reasonable, certainty is that the early institution …