Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina.
Department of Critical Care Medicine and Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
J Heart Lung Transplant. 2024 Nov;43(11):1894-1904. doi: 10.1016/j.healun.2024.07.006. Epub 2024 Jul 24.
Acute right ventricular failure (RVF) is prevalent in multiple disease states and is associated with poor clinical outcomes. Right-sided temporary mechanical circulatory support (tMCS) devices are used to unload RV congestion and increase cardiac output in cardiogenic shock (CS) with hemodynamically significant RVF. Several RV-tMCS device platforms are available; however consensus is lacking on patient selection, timing of escalation to RV-tMCS, device management, and device weaning. The purposes of this review are to 1) describe the current state of tMCS device therapies for acute RVF with CS, 2) discuss principles of escalation to RV-tMCS device therapy, 3) examine important aspects of clinical management for patients supported by RV-tMCS devices including volume management, anticoagulation, and positive pressure ventilation, and 4) provide a framework for RV-tMCS weaning.
急性右心衰竭（RVF）在多种疾病状态中较为常见，且与不良临床结局相关。右心临时机械循环支持（tMCS）设备用于在心源性休克（CS）伴血流动力学显著 RVF 时减轻 RV 淤血并增加心输出量。有多种 RV-tMCS 设备平台，但在患者选择、RV-tMCS 升级时机、设备管理和设备脱机方面缺乏共识。本综述的目的是：1）描述急性 RVF 伴 CS 的 tMCS 设备治疗现状，2）讨论升级至 RV-tMCS 设备治疗的原则，3）检查 RV-tMCS 设备支持患者的临床管理的重要方面，包括容量管理、抗凝和正压通气，4）为 RV-tMCS 脱机提供框架。
