LAUSR

Cardiogenic shock (CS) remains a leading cause of death in patients presenting with acute myocardial infarction (AMI), with short ‐ term mortality ranging from 40% to 50%. The use of mechanical circulatory support for patients presenting with AMI and CS has been increasing despite the absence of randomized control trials to suggest mortality benefits. 1 In this issue, von Lewinski et al. reported on the use of a standard operating procedure (SOP) to guide decision ‐ making in the use of mechanical circulatory support (MCS) in CS. In this report, an SOP using patient characteristics including the need for cardiopulmonary resuscitatoin, age, lactate levels, pH, and predicted response to percutaneous cornary intervention was used to help determine patient appropriateness for MCS and determine the type of support. 2 At our institution, we have established a CS Program and have implemented a CS Protocol designed for the early identification and treatment of patients in CS and is in line with the recent American Heart Association (AHA) statement. 1 The activation of a multi ‐ disciplinary team implements this protocol and emphasizes the use of invasive hemodynamics to establish the severity of CS and guide treatment strategies. When a patient presents to the catheterization laboratory with an AMI and CS is suspected, a right heart catheterization is performed first. The interventional cardiologist is responsible for the initial hemodynamic management and revascularization, simultaneously assembling a multidisciplinary team. This team is comprised of an interventional cardiologist, cardiology fellow, a cardiothoracic surgeon, a heart failure attending, and cardiac intensive care unit attending, a conference regarding optimal strategies for circulatory support that takes place, in person or by conference call.