Cardiogenic shock continues to be an unresolved clinical challenge. The initial management of cardiogenic shock includes etiology-specific treatment (e.g., coronary revascularization for acute myocardial infarction), optimization of volume and respiratory status, and administration of inotropic and vasopressor medications. However, inotropes may increase myocardial oxygen consumption, which may further worsen myocardial ischemia, can induce arrhythmias, and may not provide adequate circulatory support. Vasopressors may further decrease tissue perfusion and impair microcirculation.

As a result, interest in the potential role of short-term mechanical circulatory support in cardiogenic shock has grown and clinical uptake of these devices continues to increase.2,3  Use of the Impella (Abiomed Inc., USA) transvalvular heart pump in particular, has grown significantly.3–5  As such, anesthesiologists are increasingly likely to care for patients receiving transvalvular heart pump support and should have a thorough understanding of the device and its hemodynamic effects and perioperative considerations....

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