Kapur Navin K, Whitehead Evan H, Thayer Katherine L, Pahuja Mohit
The Cardiovascular Center for Research and Innovation, Tufts Medical Center, Boston, MA, USA.
Division of Cardiology, Detroit Medical Center/Wayne State University School of Medicine, Detroit, MI, USA.
F1000Res. 2020 Jul 29;9. doi: 10.12688/f1000research.25518.1. eCollection 2020.
Acute mechanical circulatory support (MCS) devices are widely used in cardiogenic shock (CS) despite a lack of high-quality clinical evidence to guide their use. Multiple devices exist across a spectrum from modest to complete support, and each is associated with unique risks. In this review, we summarize existing data on complications associated with the three most widely used acute MCS platforms: the intra-aortic balloon pump (IABP), Impella systems, and veno-arterial extracorporeal membrane oxygenation (VA-ECMO). We review evidence from available randomized trials and highlight challenges comparing complication rates from case series and comparative observational studies where a lack of granular data precludes appropriate matching of patients by CS severity. We further offer a series of best practices to help shock practitioners minimize the risk of MCS-associated complications and ensure the best possible outcomes for patients.
尽管缺乏高质量的临床证据来指导其使用，但急性机械循环支持（MCS）设备仍广泛应用于心源性休克（CS）。从适度支持到完全支持，有多种设备可供选择，每种设备都有其独特的风险。在本综述中，我们总结了与三种最广泛使用的急性MCS平台相关的并发症的现有数据：主动脉内球囊反搏（IABP）、Impella系统和静脉-动脉体外膜肺氧合（VA-ECMO）。我们回顾了现有随机试验的证据，并强调了比较病例系列和比较观察性研究的并发症发生率时所面临的挑战，在这些研究中，由于缺乏详细数据，无法根据CS严重程度对患者进行适当匹配。我们还提供了一系列最佳实践，以帮助休克治疗医生将MCS相关并发症的风险降至最低，并确保患者获得尽可能好的治疗效果。
