Department of Surgery, Columbia University Medical Center, New York, New York 10032, USA.
J Heart Lung Transplant. 2013 Jan;32(1):106-11. doi: 10.1016/j.healun.2012.10.005.
Mortality for refractory cardiogenic shock (RCS) remains high. However, with improving mechanical circulatory support device (MCSD) technology, the treatment options for RCS patients are expanding. We report on a recent 5-year single-center experience with MCSD for treatment of RCS.
This study was a retrospective review of adult patients who required an MCSD due to RCS in the past 5 years. We excluded those patients with post-cardiotomy shock and post-transplant cardiac graft dysfunction. In the setting of RCS, a short-term ventricular assist device (VAD) was inserted as a bridge-to-decision device. Veno-arterial extracorporeal membrane oxygenation (VA ECMO) was chosen in cases of unknown neurologic status, complete hemodynamic collapse or severe coagulopathy.
From January 2007 through January 2012, 90 patients received an MCSD for RCS, 21 (23%) of whom had active cardiopulmonary resuscitation (CPR). The etiology of RCS included acute myocardial infarction in 49% and acute decompensated heart failure in 27%. Mean age was 53±14 years, 71% were male, and 60% had an intra-aortic balloon pump. The initial approach utilized was short-term VAD in 49% and VA ECMO in 51%. Median length of support was 8 days (IQR 4 to 18 days). Exchange to implantable VAD was performed in 26% of patients. Other destinations included myocardial recovery in 18% and heart transplantation in 11%. Survival to hospital discharge was 49%. Multivariate analysis showed ongoing CPR to be an independent risk factor for mortality (OR = 5.79, 95% CI 1.285 to 26.08, p = 0.022).
In the current era, roughly half of the patients who need an MCSD for RCS survive, and roughly half of these survivors require an implantable VAD. Ongoing CPR is predictive of in-hospital mortality.
难治性心原性休克（RCS）的死亡率仍然很高。然而，随着机械循环支持设备（MCSD）技术的不断改进，RCS 患者的治疗选择正在不断扩大。我们报告了最近 5 年来，使用 MCSD 治疗 RCS 的单中心经验。
这是一项回顾性研究，纳入了过去 5 年内因 RCS 需要 MCSD 的成年患者。我们排除了那些因心脏手术后休克和移植心脏移植物功能障碍的患者。在 RCS 中，短期心室辅助装置（VAD）作为决策装置的桥接装置插入。对于神经状态未知、完全血流动力学崩溃或严重凝血功能障碍的患者，选择静脉-动脉体外膜氧合（VA ECMO）。
从 2007 年 1 月至 2012 年 1 月，90 例患者因 RCS 接受了 MCSD，其中 21 例（23%）正在进行心肺复苏（CPR）。RCS 的病因包括急性心肌梗死 49%和急性失代偿性心力衰竭 27%。平均年龄为 53±14 岁，71%为男性，60%有主动脉内球囊泵。初始治疗方法分别为短期 VAD 49%和 VA ECMO 51%。中位支持时间为 8 天（IQR 4 至 18 天）。26%的患者进行了可植入 VAD 的转换。其他治疗包括心肌恢复 18%和心脏移植 11%。住院期间的存活率为 49%。多变量分析显示，持续 CPR 是死亡率的独立危险因素（OR=5.79，95%CI 1.285 至 26.08，p=0.022）。
在当前时代，大约一半需要 MCSD 治疗 RCS 的患者存活，其中大约一半的幸存者需要可植入 VAD。持续 CPR 可预测院内死亡率。
