2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.
Curr Opin Crit Care. 2021 Aug 1;27(4):440-446. doi: 10.1097/MCC.0000000000000837.
Cardiogenic shock (CS) therapy involving catecholamines, inotropes, fluids and revascularization is often insufficient, and short-term mortality remains 50%. Different treatment algorithms and mechanical circulatory support devices (MCS) have been increasingly used in the treatment of CS. Coronavirus disease 2019 (COVID-19) pandemic is a major challenge faced by intensive care medicine providers inevitably influencing also CS management.
There is a lack of prospective data as well as international consensus regarding CS classification, patient risk stratification, and MCS use. Veno-arterial extracorporeal membrane oxygenation is considered the first line MCS in refractory CS and Impella the MCS of choice for the left ventricle unloading. Several ongoing randomized trials will provide much-needed evidence for MCS use in the coming years. COVID-19 infection is associated with several cardiovascular disorders complicated by CS and more data regarding the prevalence and mortality of CS during COVID-19 infection are needed.
This review summarizes current trends in the use of MCS in CS and discusses differences in CS management during the COVID-19 pandemic. Careful patient selection, early MCS initiation, and comprehensive intensive care by experienced team is key to successful outcome in patients with refractory CS.
涉及儿茶酚胺、正性肌力药、液体和血运重建的心肌梗死性休克（CS）治疗往往是不够的，短期死亡率仍为 50%。不同的治疗算法和机械循环支持设备（MCS）已越来越多地用于 CS 的治疗。2019 年冠状病毒病（COVID-19）大流行是重症监护医学提供者面临的重大挑战，不可避免地也会影响 CS 的管理。
CS 分类、患者风险分层和 MCS 使用方面缺乏前瞻性数据和国际共识。静脉动脉体外膜肺氧合被认为是难治性 CS 的一线 MCS，Impella 是左心室卸载的首选 MCS。未来几年将有几项正在进行的随机试验为 MCS 的使用提供急需的证据。COVID-19 感染与多种心血管疾病并发 CS，需要更多关于 COVID-19 感染期间 CS 的患病率和死亡率的数据。
本文综述了目前 MCS 在 CS 中的应用趋势，并讨论了 COVID-19 大流行期间 CS 管理的差异。仔细的患者选择、早期 MCS 启动和由经验丰富的团队进行全面的重症监护是难治性 CS 患者获得成功结果的关键。
