Goldstein Daniel, Neragi-Miandoab Siyamek
Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, 3400 Bainbridge Avenue, Bronx, NY 10467, USA.
Curr Heart Fail Rep. 2011 Mar;8(1):51-8. doi: 10.1007/s11897-010-0041-5.
While great strides have been made in the management of heart failure syndromes, acute refractory cardiogenic shock carries a dismal prognosis. Initial treatment with inotropes and balloon counterpulsation can restore hemodynamics, but many patients deteriorate and succumb to multisystem organ failure if timely mechanical circulatory support is not established. Institution of support is intended as a life-saving measure where the final treatment strategy remains uncertain. This scenario is referred to as "bridge to decision." Notably, most of these patients present to community hospitals, where advanced mechanical support technologies are scarce or nonexistent. Delays in referral to a tertiary center contribute to the bleak outcomes. Herein, we review the initial management of acute heart failure and refractory cardiogenic shock, profile the typical patient, delineate current options for mechanical support in patients with acute refractory cardiogenic shock, and propose suggestions for the establishment of a seamless transfer process of these ill patients to tertiary centers.
虽然在心力衰竭综合征的管理方面已经取得了巨大进展，但急性难治性心源性休克的预后仍然很差。使用血管活性药物和球囊反搏进行初始治疗可以恢复血流动力学，但如果不及时建立机械循环支持，许多患者会病情恶化并死于多系统器官衰竭。在最终治疗策略仍不确定的情况下，启动支持治疗旨在作为一种挽救生命的措施。这种情况被称为“决策桥梁”。值得注意的是，这些患者大多就诊于社区医院，而那里先进的机械支持技术稀缺或根本不存在。转诊至三级中心的延迟导致了严峻的后果。在此，我们回顾急性心力衰竭和难治性心源性休克的初始管理，描述典型患者的特征，阐述急性难治性心源性休克患者当前的机械支持选择，并就如何建立这些重症患者无缝转诊至三级中心的流程提出建议。
