Individualized mechanical circulatory support is necessary as increased hemodynamic support does not uniformly improve survivalMechanical Support for Cardiogenic Shock Does Not Uniformly Improve Survival

Despite advances in early recognition, aetiology-directed therapy, intensive cardiovascular care and short-term mechanical circulatory support (MCS), cardiogenic shock (CS) remains associated with high mortality and morbidity. MCS can restore systemic perfusion and stabilise patients as a bridge to recovery or advanced heart failure therapies, or as a bridge-to-decision when the final therapeutic destination remains uncertain. However, appropriate patient and device selection remains challenging. The optimal timing of support is uncertain, as both premature implantation and delayed use in advanced shock may limit benefit while increasing complications. Device selection should therefore be individualised according to the predominant patient phenotype, including left ventricular, right ventricular or biventricular failure, concomitant respiratory failure, vascular access and anatomical considerations. Randomised trials have focused predominantly on acute myocardial infarction-related CS, whereas data in heart failure-related and acute-on-chronic CS remain limited. Recent trials have also shown that greater haemodynamic support does not uniformly translate into improved survival, highlighting the importance of matching device physiology to shock phenotype and clinical trajectory. MCS is associated with clinically relevant complications, including major bleeding, haemolysis, limb ischaemia, stroke, thrombosis and vascular injury. Accordingly, its use should be considered within a strategy integrating reversibility, neurological prognosis, recovery potential, a realistic definitive therapeutic strategy, technical feasibility and anticipated complication risk. This Mini Review summarises contemporary indications, devices and complications of MCS in CS, with emphasis on phenotype-guided selection, timing, intensive care management and current evidence gaps.