Department of Cardiothoracic Surgery, Level 12, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore.
Curr Cardiol Rep. 2018 Aug 16;20(10):87. doi: 10.1007/s11886-018-1041-4.
This review aims to discuss the role of ECMO in the treatment of cardiogenic shock in heart failure.
Trials done previously have shown that IABP does not improve survival in cardiogenic shock compared to medical treatment, and that neither Impella 2.5 nor TandemHeart improves survival compared to IABP. The "IMPRESS in severe shock" trial compared Impella CP with IABP and found no difference in survival. A meta-analysis of cohort studies comparing ECMO with IABP showed 33% improved 30-day survival with ECMO (risk difference 33%; 95% CI 14-52%; p = 0.0008; NNT 3). ECMO is indicated in medically refractory cardiogenic shock. ECMO can be considered in cardiogenic shock patients with estimated mortality of more than 50%. ECMO is probably the MCS of choice in cardiogenic shock with; biventricular failure, respiratory failure, life-threatening arrhythmias and cardiac arrest.
本文旨在探讨体外膜肺氧合（ECMO）在心力衰竭性心原性休克治疗中的作用。
既往试验表明，与药物治疗相比，主动脉内球囊反搏（IABP）并不能提高心原性休克患者的生存率，Impella 2.5 或 TandemHeart 也不比 IABP 更能提高生存率。“IMPRESS 在严重休克中”试验将 Impella CP 与 IABP 进行了比较，发现生存率无差异。一项比较 ECMO 与 IABP 的队列研究荟萃分析显示，ECMO 可使 30 天生存率提高 33%（风险差异 33%；95%CI 14-52%；p=0.0008；NNH 3）。在药物难治性心原性休克中应使用 ECMO。对于预计死亡率超过 50%的心原性休克患者，可以考虑使用 ECMO。对于存在双心室衰竭、呼吸衰竭、威胁生命的心律失常和心脏骤停的心原性休克患者，ECMO 可能是首选的 MCS。
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