den Uil Corstiaan A, Galli Giorgia, Jewbali Lucia S, Caliskan Kadir, Manintveld Olivier C, Brugts Jasper J, van Mieghem Nicolas M, Lenzen Mattie J, Boersma Eric, Constantinescu Alina A
Thoraxcenter, Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.
Cardiology. 2017;138(1):1-8. doi: 10.1159/000471846. Epub 2017 May 13.
Little is known about circulatory support in cardiogenic shock (CS) from other causes than the acute coronary syndrome or after cardiotomy. We evaluated the effects of first-line intra-aortic balloon pump (IABP) support in this subpopulation of CS patients.
A retrospective study was performed in 27 patients with CS from end-stage cardiomyopathy supported firstly by IABP in the years 2011-2016.
At 24 h, lactate decreased from 3.2 (2.1-6.8) to 1.8 (1.2-2.2) mmol/L (p < 0.001). Eighteen patients (67%) defined as IABP responders were successfully bridged to either recovery (n = 7), left ventricular assist device (n = 5), or heart transplantation (n = 6). IABP failed in 9 patients (non-responders, 33%) who either died (n = 7) or needed support by extracorporeal membrane oxygenation (n = 2). At 24 h of IABP support, urinary output was higher (2,660 [1,835-4,440] vs. 1,200 [649-2,385] mL; p = 0.02) and fluid balance more negative (-1,564 [-2,673 to -1,086] vs. -500 [-930 to +240] mL; p < 0.001) in responders than non-responders. Overall survival at 1 year was 63%.
In most patients, first-line support by IABP in end-stage cardiomyopathy is associated with improvement in organ perfusion and clinical stabilisation for at least 24 h allowing time for decision making on next therapies.
除急性冠状动脉综合征或心脏手术后的心源性休克（CS）外，其他原因导致的CS的循环支持情况鲜为人知。我们评估了一线主动脉内球囊反搏（IABP）支持对该亚组CS患者的影响。
对2011年至2016年期间首先接受IABP支持的27例终末期心肌病导致的CS患者进行了一项回顾性研究。
24小时时，乳酸水平从3.2（2.1 - 6.8）mmol/L降至1.8（1.2 - 2.2）mmol/L（p < 0.001）。18例（67%）被定义为IABP反应者的患者成功过渡到恢复（n = 7）、左心室辅助装置（n = 5）或心脏移植（n = 6）。9例患者（无反应者，33%）IABP治疗失败，其中7例死亡，2例需要体外膜肺氧合支持。在IABP支持24小时时，反应者的尿量更高（2,660 [1,835 - 4,440] vs. 1,200 [649 - 2,385] mL；p = 0.02），液体平衡更负（-1,564 [-2,673至-1,086] vs. -500 [-930至+240] mL；p < 0.001）。1年总生存率为63%。
在大多数患者中，终末期心肌病患者接受IABP一线支持可改善器官灌注并实现至少24小时的临床稳定，为下一步治疗决策留出时间。
