Postcardiotomy cardiogenic shock: the role of ventricular assist devices.

Postcardiotomy cardiogenic shock (PCCS) remains a life-threatening complication of cardiac surgery. Although survival rates have doubled in the past decade, PCCS continues to result in significant morbidity and mortality. Factors contributing to improved outcomes include early recognition of shock, early application of ventricular assist device (VAD) technology in cases of refractory shock, better technology, better surgical application (less technical error), application of treatment protocols, and assignment of management to specially trained personnel. A systematic approach to the management of PCCS can facilitate consistent care. This same approach can be applied to all forms of shock. VAD technology provides an opportunity for survival when other medical and surgical options fail.