Checchia Paul A
Divisions of Critical Care Medicine and Cardiology, St. Louis Children's Hospital, Washington University School of Medicine, One Children's Place, NWT 8th Floor, St. Louis, MO, 63110, USA,
Curr Treat Options Cardiovasc Med. 2011 Oct;13(5):414-24. doi: 10.1007/s11936-011-0140-y.
The treatment of cardiovascular failure in the perioperative period with the use of mechanical circulatory support is a well-recognized, well-developed, and commonly utilized treatment modality. Regardless of the exact circumstances of initiation, the use of a support device is a "bridge." Where there has been an acute myocardial insult, short-term assist devices can serve as a "bridge to immediate survival," a "bridge to recovery," or even a "bridge to the next decision." Mechanical circulatory support can serve as a treatment of cardiovascular decompensation caused by myocarditis, acute myocardial insult, low cardiac output following surgery, and congenital heart disease. The utilization of such support carries significant risks such as bleeding, infection, and thrombosis. However, these can be minimized in order to allow for the safe and effective deployment of this therapeutic strategy. One specific therapeutic domain in which these devices provide immediate impact is during cardiac arrest. Although outcomes of cardiac arrest remain poor, use of a mechanical device as an intervention has allowed salvage of otherwise certain mortality. However, it is important to note that the utility of support was most pronounced in patients that were not on either extreme of the survival prediction curve. This can be best summarized by the concept of "not too early, not too late." Therefore, it is the responsibility of the entire care team to find the appropriate patient population in which to "pull the trigger" on mechanical support as a therapy. This decision point is supported by a monitoring strategy that can be utilized to predict deterioration and intervene adequately. Most importantly, an effective monitoring strategy allows the practitioner to judge the effectiveness of treatment and support strategies and make adjustments in a timely manner, potentially with mechanical support in the perioperative period.
围手术期使用机械循环支持治疗心血管衰竭是一种公认的、成熟的且常用的治疗方式。无论启动的具体情况如何，使用支持装置都是一座“桥梁”。在发生急性心肌损伤时，短期辅助装置可作为“通向即刻生存的桥梁”“通向康复的桥梁”，甚至是“通向下一步决策的桥梁”。机械循环支持可用于治疗由心肌炎、急性心肌损伤、术后低心排血量以及先天性心脏病引起的心血管代偿失调。使用这种支持会带来诸如出血、感染和血栓形成等重大风险。然而，可以将这些风险降至最低，以便安全有效地实施这一治疗策略。这些装置能立即产生影响的一个特定治疗领域是在心脏骤停期间。尽管心脏骤停的预后仍然很差，但使用机械装置作为一种干预手段已使原本必死无疑的患者得以挽救。然而，需要注意的是，支持的效用在生存预测曲线两端的患者中并不明显。这可以用“不太早，不太晚”这一概念来最好地概括。因此，整个护理团队有责任找到合适的患者群体，以便在其中“触发”机械支持作为一种治疗手段。这一决策点得到了一种监测策略的支持，该策略可用于预测病情恶化并进行充分干预。最重要的是，有效的监测策略使从业者能够判断治疗和支持策略的有效性，并及时进行调整，可能包括围手术期的机械支持。
