Musa Tarique Al, Chue Colin Dominic, Lim Hoong Sern
Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, B15 2TH, UK.
Curr Heart Fail Rep. 2017 Oct;14(5):365-375. doi: 10.1007/s11897-017-0349-5.
Cardiogenic shock from decompensated heart failure is associated with significant morbidity and mortality. Mechanical circulatory support (MCS) improves haemodynamics and reverses organ dysfunction in critically ill patients with cardiogenic shock. This paper summarises the main modalities of mechanical support and their physiological impact, practical considerations, advantages and disadvantages to facilitate a holistic approach in managing a potentially lethal pathology.
To date, there remains a lack of large randomised controlled trials to support the use of any mechanical support strategy. Consequently, meta-analyses, registry data and expert consensus in the form of society guidelines are relied upon. Currently, randomised trials are in progress to assess the efficacy of a percutaneous assist device (Impella) and extracorporeal membrane oxygenation. Mechanical support options are centred around the use of counter pulsation and percutaneous assist devices and the use of an extracorporeal pump and are hence varied in means of application, degree of haemodynamic benefit and potential complications. Regardless of future innovations, a timely multidisciplinary approach that incorporates both patient and institutional considerations will always be crucial to a successful outcome.
失代偿性心力衰竭所致的心源性休克与显著的发病率和死亡率相关。机械循环支持（MCS）可改善重症心源性休克患者的血流动力学并逆转器官功能障碍。本文总结了机械支持的主要方式及其生理影响、实际考量因素、优缺点，以促进对这一潜在致命病症进行整体管理。
迄今为止，仍缺乏大型随机对照试验来支持使用任何机械支持策略。因此，依赖于荟萃分析、注册数据以及以学会指南形式呈现的专家共识。目前，正在进行随机试验以评估经皮辅助装置（Impella）和体外膜肺氧合的疗效。机械支持选项围绕反搏和经皮辅助装置的使用以及体外泵的使用展开，因此在应用方式、血流动力学获益程度和潜在并发症方面各不相同。无论未来有何创新，结合患者和机构因素的及时多学科方法对于成功治疗结果始终至关重要。
