From the Duke Clinical Research Institute, Durham, NC.
Circ Cardiovasc Interv. 2017 May;10(5). doi: 10.1161/CIRCINTERVENTIONS.116.004337.
Despite a high rate of early revascularization and use of intra-aortic balloon pump counterpulsation therapy, the prognosis of patients with cardiogenic shock has remained poor. In the hopes of improving outcomes, clinicians are increasingly turning to percutaneous left and right mechanical circulatory support devices. Until recently, the evidence base for these devices had consisted only of observational data, meta-analyses, and small feasibility trials. In this article, we describe the contemporary outcomes of patients with cardiogenic shock, the hemodynamics of cardiogenic shock, and hemodynamic effects of percutaneous mechanical circulatory support devices. We then use this discussion to provide clinicians with a useful framework for understanding when selecting between or while managing patients with a percutaneous mechanical circulatory support devices. We critically review the recently published data for and against the use of commercially available devices-the intra-aortic balloon pump counterpulsation, the Impella system, the TandemHeart, and venous-arterial extracorporeal membrane oxygenation-and highlight gaps in our understanding. Given such gaps, a consensus multidisciplinary approach that combines expertise from interventional cardiologists, heart failure specialists, cardiac surgeons, and cardiac anesthesiologists may help pair the right patient with the right device at the right time.
尽管早期血运重建和主动脉内球囊反搏治疗的比例很高，但心源性休克患者的预后仍然很差。为了改善预后，临床医生越来越多地转向使用经皮左、右机械循环支持装置。直到最近，这些设备的证据基础仅包括观察性数据、荟萃分析和小型可行性试验。在本文中，我们描述了心源性休克患者的当代结局、心源性休克的血液动力学以及经皮机械循环支持装置的血液动力学效应。然后，我们利用这一讨论为临床医生提供一个有用的框架，以了解在选择或管理经皮机械循环支持装置患者时的决策依据。我们批判性地回顾了最近关于商业上可用设备（主动脉内球囊反搏、Impella 系统、TandemHeart 和静脉-动脉体外膜肺氧合）的使用的正反两方面数据，并强调了我们理解上的差距。鉴于存在这些差距，一个结合了介入心脏病专家、心力衰竭专家、心脏外科医生和心脏麻醉师专业知识的多学科共识方法，可能有助于在正确的时间为正确的患者选择正确的设备。
