Saggu Jay S, Seelhammer Troy G, Esmaeilzadeh Sarvie, Roberts John A, Radosevich Misty A, Ripoll Juan G, Soto Juan C Diaz, Wieruszewski Patrick M, Bohman J Kyle K, Wittwer Erica, Archie Chinyere, Nemani Lakshmi, Nabzdyk Christoph G S
Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA.
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
J Cardiothorac Vasc Anesth. 2025 Apr;39(4):1049-1066. doi: 10.1053/j.jvca.2024.12.007. Epub 2024 Dec 8.
Cardiogenic shock (CS) in acute myocardial infarction (AMI) is a life-threatening syndrome characterized by systemic hypoperfusion that can quickly progress to multiorgan failure and death. Various devices and configurations of mechanical circulatory support (MCS) exist to support patients, each with unique pathophysiological characteristics. The Intra-aortic balloon pump can improve coronary perfusion, decrease afterload, and indirectly augment cardiac output. TandemHeart, a percutaneous ventricular assist device, can decrease left ventricular preload and directly augment cardiac output. Neither the intra-aortic balloon pump nor the percutaneous ventricular assist device has been shown to decrease mortality in the revascularization era. Venoarterial extracorporeal membrane oxygenation can offer complete cardiopulmonary support; however, it has not been shown to decrease mortality. Recent studies have indicated that microaxial flow pumps, such as Abiomed's Impella family of devices, can decrease mortality in the AMI-CS population. Managing AMI-CS requires careful clinical assessment, as no single MCS device is universally effective, and device-related complications are common. While venoarterial extracorporeal membrane oxygenation provides complete support, it has not demonstrated a mortality benefit in major trials and carries significant risks. In contrast, microaxial flow pumps have shown a mortality benefit but with higher complication rates. Ongoing research and advancements aim to refine MCS strategies, improve device safety, and enhance patient outcomes.
急性心肌梗死（AMI）所致的心源性休克（CS）是一种危及生命的综合征，其特征为全身灌注不足，可迅速进展为多器官功能衰竭和死亡。存在多种机械循环支持（MCS）设备及配置用于支持患者，每种都有独特的病理生理特征。主动脉内球囊反搏可改善冠状动脉灌注、降低后负荷并间接增加心输出量。经皮心室辅助装置TandemHeart可降低左心室前负荷并直接增加心输出量。在血运重建时代，主动脉内球囊反搏和经皮心室辅助装置均未显示能降低死亡率。静脉-动脉体外膜肺氧合可提供完全的心肺支持；然而，它也未显示能降低死亡率。最近的研究表明，微轴流泵，如Abiomed公司的Impella系列设备，可降低AMI-CS患者的死亡率。处理AMI-CS需要仔细的临床评估，因为没有一种MCS设备是普遍有效的，且与设备相关的并发症很常见。虽然静脉-动脉体外膜肺氧合提供了完全支持，但在主要试验中它并未显示出死亡率获益，且存在重大风险。相比之下，微轴流泵已显示出死亡率获益，但并发症发生率较高。正在进行的研究和进展旨在优化MCS策略、提高设备安全性并改善患者预后。
