Esposito Michele L, Kapur Navin K
The Cardiovascular Center, Tufts Medical Center, 800 Washington Street, Boston, Massachusetts, 02339, USA.
F1000Res. 2017 May 22;6:737. doi: 10.12688/f1000research.11150.1. eCollection 2017.
Cardiogenic shock (CS) remains a major cause of in-hospital mortality in the setting of acute myocardial infarction. CS begins as a hemodynamic problem with impaired cardiac output leading to reduced systemic perfusion, increased residual volume within the left and right ventricles, and increased cardiac filling pressures. A critical step towards the development of future algorithms is a clear understanding of the treatment objectives for CS. In this review, we introduce the "door to support" time as an emerging target of therapy to improve outcomes associated with CS, define four key treatment objectives in the management of CS, discuss the importance of early hemodynamic assessment and appropriate selection of acute mechanical circulatory support (AMCS) devices for CS, and introduce a classification scheme that identifies subtypes of CS based on cardiac filling pressures.
心源性休克（CS）仍是急性心肌梗死住院患者死亡的主要原因。CS起始于血流动力学问题，心输出量受损导致全身灌注减少、左右心室内残余血量增加以及心脏充盈压升高。制定未来算法的关键一步是清楚了解CS的治疗目标。在本综述中，我们引入“从入院到获得支持”时间作为一种新的治疗靶点，以改善与CS相关的预后，明确CS管理中的四个关键治疗目标，讨论早期血流动力学评估以及为CS恰当选择急性机械循环支持（AMCS）设备的重要性，并介绍一种基于心脏充盈压识别CS亚型的分类方案。
