title: ["Catecholamine refractory" cardiogenic shock? "Bridging-to-recovery" by implantation of a percutaneous cardiac assist device].
abstract: METHODS
  A 27-year-old man presented with acute dyspnea and a previous respiratory tract infection with progressive dyspnoea and chest pain over 2 weeks. Clinical findings revealed severe cardiac failure with development of cardiogenic shock and need for adrenergic drug therapy for circulatory support.
  
  
  METHODS
  The electrocardiogram showed a sinus tachycardia with unspecific T-wave-inversions, the echocardiogram revealed a dilated left ventricle and severely reduced systolic LV-function. An acute coronary syndrome could be excluded by coronary angiogram.
  
  
  METHODS
  A myocardial biopsy was taken to exclude giant cell myocarditis. The immediate initiation of a mechanical circulatory support by an Extracorporal Membrane Oxygenator (ECMO) facilitated rapid hemodynamic stabilization and recovery of organ function.
  
  
  CONCLUSIONS
  A drug-only circulatory support very often does not enable stabilization of a patient in progressive cardiogenic shock and cannot prevent multiorgan dysfunction. Therefore implantation of an assist device facilitates a "bridging-to-recovery" or a "bridging-to transplant" concept in critically ill patients presenting with cardiogenic shock. The bridging also allows for reviewing etiology and evaluation of further treatment options. In case of recovery continuous care in a specialized Heart Failure Clinic can help to maintain the clinical status and offer frequent reevaluation of cardiac status and therapeutic concepts.
authors.affiliation: Klinik für Innere Medizin/ Kardiologie, Herzzentrum Leipzig GmbH der Universität Leipzig. johannes_wilde@web.de
authors.forename: J
authors.initials: J
authors.lastname: Wilde
authors.forename: K
authors.initials: K
authors.lastname: Klingel
authors.forename: R
authors.initials: R
authors.lastname: Kandolf
authors.forename: G
authors.initials: G
authors.lastname: Schuler
authors.forename: M
authors.initials: M
authors.lastname: Sandri
mesh_terms: D000328:Adult; D019969:Amphetamine-Related Disorders / Q000150:complications / Q000628:therapy; D001706:Biopsy; D009202:Cardiomyopathies / Q000175:diagnosis / Q000473:pathology / Q000628:therapy; D002395:Catecholamines / Q000008:administration & dosage*; D003299:Cooperative Behavior; D004351:Drug Resistance; D004452:Echocardiography; D004837:Epinephrine / Q000008:administration & dosage*; D015199:Extracorporeal Membrane Oxygenation; D006353:Heart-Assist Devices; D006699:Home Care Services; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D008694:Methamphetamine; D009205:Myocarditis / Q000175:diagnosis / Q000473:pathology / Q000628:therapy; D009206:Myocardium / Q000473:pathology; D010348:Patient Care Team; D062645:Percutaneous Coronary Intervention; D011474:Prosthesis Design; D012770:Shock, Cardiogenic / Q000175:diagnosis / Q000628:therapy*
chemical_list: D002395:Catecholamines; D008694:Methamphetamine; D004837:Epinephrine