Alvarez Villela Miguel, Clark Rachel, William Preethi, Sims Daniel B, Jorde Ulrich P
Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, United States.
Division of Cardiology, Jacobi Medical Center, Albert Einstein College of Medicine, New York, NY, United States.
Front Cardiovasc Med. 2021 Sep 16;8:712594. doi: 10.3389/fcvm.2021.712594. eCollection 2021.
Outcomes for cardiogenic shock (CS) patients remain relatively poor despite significant advancements in primary percutaneous coronary interventions (PCI) and temporary circulatory support (TCS) technologies. Mortality from CS shows great disparities that seem to reflect large variations in access to care and physician practice patterns. Recent reports of different models to standardize care in CS have shown considerable potential at improving outcomes. The creation of regional, integrated, 3-tiered systems, would facilitate standardized interventions and equitable access to care. Multidisciplinary CS teams at Level I centers would direct care in a hub-and-spoke model through jointly developed protocols and real-time shared decision making. Levels II and III centers would provide early access to life-saving therapies and safe transfer to designated hub centers. In regions with large geographical distances, the implementation of telemedicine-cardiac intensive care unit (CICU) care can be an important resource for the creation of effective systems of care.
尽管在直接经皮冠状动脉介入治疗（PCI）和临时循环支持（TCS）技术方面取得了重大进展，但心源性休克（CS）患者的预后仍然相对较差。CS导致的死亡率存在很大差异，这似乎反映了在获得医疗服务和医生实践模式方面的巨大差异。最近关于CS标准化护理不同模式的报告显示，在改善预后方面具有相当大的潜力。创建区域一体化的三级系统将有助于标准化干预措施并公平获得医疗服务。一级中心的多学科CS团队将通过联合制定的方案和实时共享决策，以中心辐射模式指导护理。二级和三级中心将提供早期获得救生治疗的机会，并安全转诊至指定的中心枢纽。在地理距离较大的地区，实施远程医疗心脏重症监护病房（CICU）护理可以成为创建有效护理系统的重要资源。
