When NOT to use short-term mechanical circulatory support

Commentary: Restorative resuscitation after cardiac arrest with Controlled Automated Reperfusion of the whoLe body (CARL)—the Freiburg approach with guiding principles from cardiac surgery

“… 3 As experience with CARL matures, it is possible that the indications and management pathways for this platform will be refined. 12 , 13 Future data will influence their evolution to address the “metabolic shock” and the reperfusion injury that accompany resuscitation after cardiac arrest. 3 , 11 The current clinical pathways may be adapted to include this tailored perfusion management, if it proves effective in clinical trials.…”

“… 1 , 2 , 5 The implementation of resuscitation goals from CARL may limit reperfusion injury and may foster more precise care in resuscitation after cardiac arrest. 8 , 9 , 10 , 11 , 12 , 13 …”

Commentary: It's tempting to jump down the rabbit hole

“…As we continue to push the boundaries of medicine and blur the lines between life and death, it becomes increasingly important to define what is and what isn't futility of care. As Rao and Billia 2 aptly conclude in their article on when not to use temporary mechanical circulatory support (MCS), “the desire to prolong life can easily transform into an unintentional prolongation of death.”…”

Commentary: Futility in the age of modern mechanical circulatory support

“…This review by Rao and Billia 1 provides insightful, modern criteria for offering mechanical circulatory support (MCS) to patients with acute decompensated heart failure. Patients requiring venoarterial support represent a frail cohort whose overall survival remains only approximately 50% by current Extracorporeal Life Support Organization reports.…”