Myers Timothy J
Medical & Scientific Consulting Services, LLC, 4803 Valerie St., Bellaire, TX 77401, USA.
AACN Adv Crit Care. 2012 Jan-Mar;23(1):55-68. doi: 10.1097/NCI.0b013e318240e369.
Morbidity and mortality in patients with cardiogenic shock remain high despite the recent advances in therapy. New temporary ventricular assist devices (VADs) that are rapidly applied to normalize cardiac output in patients with severe heart failure are being used more frequently. Bridge to decision describes the temporary use of a VAD to stabilize critically ill patients until complete diagnostic tests are performed and decisions about more definitive therapy are made. The CentriMag, TandemHeart, and Impella VADs offer versatility for use in many patients and in multiple hospital settings. These VADs provide continuous blood flow, altering the usual assessment of arterial blood pressure. Patients are usually immobilized during support to prevent dislodgement of cannulas. Anticoagulation therapy is commonly required, and bleeding is a frequent complication. Infection prevention measures must be used to avoid septic complications. In the past 10 years, clinical experience with these devices has expanded, but they remain underused.
尽管近年来治疗方法有所进步，但心源性休克患者的发病率和死亡率仍然很高。新型临时心室辅助装置（VAD）被越来越频繁地用于严重心力衰竭患者，以迅速使心输出量恢复正常。过渡到决策是指临时使用VAD来稳定重症患者，直到完成全面的诊断测试并做出关于更明确治疗的决策。CentriMag、TandemHeart和Impella VAD在许多患者和多种医院环境中都具有广泛的适用性。这些VAD提供持续的血流，改变了对动脉血压的常规评估。在支持治疗期间，患者通常需要固定，以防止插管移位。通常需要进行抗凝治疗，出血是常见的并发症。必须采取感染预防措施以避免败血症并发症。在过去10年中，这些装置的临床经验有所增加，但它们的使用仍然不足。
