skip to main content

Cardiogenic Shock - Bridge to Transplant — EECC MCQ

Instant feedback + full explanation. One question, done properly.

HardHeart FailureCardiogenic Shock - Bridge to TransplantEECC

A 45-year-old man with non-ischaemic DCM (LVEF 15%) is listed for cardiac transplantation. While awaiting a donor, he develops refractory cardiogenic shock requiring inotropic support with dobutamine and noradrenaline. His lactate is 4.2 mmol/L and rising despite escalating inotropes. He has no contraindications to mechanical support. What is the most appropriate bridging strategy?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Durable left ventricular assist device as bridge to transplant

Explanation lettering: B = shown as A · D = shown as B · E = shown as D · A = shown as E

This patient has refractory cardiogenic shock while awaiting transplant. Per the 2021 ESC HF Guidelines, a durable LVAD should be considered as a bridge to transplant (Class IIa). Given the anticipated wait, a durable device provides the best medium-term support. IABP (A) provides insufficient support for refractory shock. Impella (B) is a short-term device. VA-ECMO (D) is for acute collapse as a bridge to decision but not for prolonged support. Escalating inotropes (E) is unlikely to reverse the trajectory.

Reference: ESC (2021): Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure