Life-Threatening Cardiogenic Shock During Chemotherapy: The Role of Mechanical Ventricular Support in Cardio-Oncology Patients

Background: Acute cardiogenic shock is a possible and life-threatening complication of anthracycline therapy. Data on the use of percutaneous mechanical circulatory support in this setting remain limited. Case summary: A 50-year-old woman developed cardiogenic shock 2 days after receiving epirubicin-based chemotherapy. Owing to progressive hemodynamic instability despite inotropic support, an Impella CP was needed. Extracorporeal membrane oxygenation (ECMO) was avoided given chemotherapy-related pancytopenia and the need to minimize bleeding risk. Progressive hemodynamic recovery was achieved, with normalization of biventricular function at follow-up. Discussion: This case illustrates acute, reversible anthracycline-induced cardiotoxicity managed with mechanical circulatory support. In thrombocytopenic cardio-oncology patients, a stepwise approach with inotropes and Impella device may represent a safer alternative to ECMO. Early and tailored interventions are key in this high-risk population. Take-home messages: Anthracycline-induced cardiotoxicity may be acute and unpredictable. In cardio-oncology patients with high bleeding risk, an Impella device may represent a safer and effective alternative to ECMO for circulatory support.