Visconti Luigi Oltrona, Camporotondo Rita, Ferlini Marco, Savastano Simone, Annoni Ginevra, Fasolino Alessandro
Divisione di Cardiologia, IRCCS Policlinico San Matteo, Pavia.
Dipartimento di Medicina Molecolare, Università degli Studi, Pavia.
G Ital Cardiol (Rome). 2024 Jun;25(6):410-423. doi: 10.1714/4269.42465.
Mortality for cardiogenic shock is still high despite optimal pharmacological therapy. Therefore, active mechanical circulatory support devices are increasingly used; venoarterial extracorporeal membrane oxygenation (VA-ECMO) enables full circulatory and respiratory support. However, recent data show that in patients with infarct-related shock unselected early use of VA-ECMO does not improve survival and is associated with major bleeding and peripheral ischemic complications. Nowadays, waiting for the results of definitive randomized controlled trials, the main indication for ECMO utilization is in selected patients with cardiac arrest, in those with shock for advanced heart failure refractory to conventional therapy, in those with fulminant myocarditis, in patients candidate for heart transplant or ventricular assistance, especially in presence of respiratory insufficiency and severe biventricular dysfunction. An important recommendation is its utilization in specialized, high-volume centers in the setting of hub and spoke hospitals.
尽管进行了最佳药物治疗，心源性休克的死亡率仍然很高。因此，主动式机械循环支持装置的使用越来越多；静脉-动脉体外膜肺氧合（VA-ECMO）可实现全面的循环和呼吸支持。然而，最近的数据表明，在未经过选择的梗死相关休克患者中，早期使用VA-ECMO并不能提高生存率，且与严重出血和外周缺血并发症相关。如今，在等待确定性随机对照试验结果的同时，ECMO使用的主要指征是在选定的心脏骤停患者、对传统治疗无效的晚期心力衰竭休克患者、暴发性心肌炎患者、心脏移植或心室辅助候选患者中，特别是在存在呼吸功能不全和严重双心室功能障碍的情况下。一项重要的建议是在中心医院和周边医院组成的医疗网络中，在专业的、高容量的中心使用它。
