Temporary circulatory support for cardiogenic shock: technology overview and limitations

INTRODUCTION: Temporary mechanical circulatory support (tMCS) has become essential in managing severe cardiac dysfunction, particularly refractory cardiogenic shock (CS). Despite widespread adoption, the optimal use of tMCS is often guided by institutional experience rather than robust evidence, leaving questions about device selection and patient outcomes. AREAS COVERED: We conducted a structured literature review of studies published in major databases (PubMed), using keywords such as intra-aortic balloon pump, veno-arterial extracorporeal membrane oxygenation, percutaneous ventricular assist devices, cardiogenic shock, and related terms. Key clinical scenarios reviewed include acute myocardial infarction-related CS, post-cardiotomy shock, and support for high-risk percutaneous coronary interventions. We critically examine randomized controlled trials, extensive observational studies, and consensus statements published in the last five years. EXPERT OPINION: While tMCS has revolutionized the management of CS, its optimal use is still limited by a lack of high-quality evidence, ongoing device-related complications, and economic challenges. Future advancements in device technology, patient stratification, and standardized protocols, alongside continued research and innovation, are essential to improve outcomes and broaden accessibility.