Contemporary Management of Cardiogenic Shock During Pregnancy

Cardiogenic shock is the most extreme cardiovascular disease state during pregnancy. Peripar-tum cardiomyopathy is the most common cause of cardiogenic shock toward the end of preg-nancy and in the early postpartum period. Therapy for cardiogenic shock relies on appropriate phenotyping of shock etiology, severity and ventricular predominance, which are critical in the appropriate selection of medical and mechanical therapy. Mechanical circulatory support may be used as a bridge to recovery or as definitive therapy. Intra-aortic balloon pumps, percutaneous left ventricular assist devices and venoarterial extracorporeal circulatory devices have been successfully used in pregnancy and the postpartum period. The most com-monly used mechanical therapy in the pregnant patient is extracorporeal membranous oxy-genation circulatory support. The use of mechanical circulatory devices in peripartum cardiomyopathy has contributed to improved survival rates in recent years. Further efforts to identify the optimal mechanical circulatory support strategy for peripartum cardiomyopathy and cardiogenic shock in the peripartum period are needed. (J Cardiac Fail 2023;29:193-209)