Maigrot Jean-Luc A, Wakefield Brett J, Donaldson Chase M, Weiss Aaron J
Department of Thoracic & Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA.
Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Curr Cardiol Rep. 2025 Jan 10;27(1):14. doi: 10.1007/s11886-024-02152-0.
This article discusses a tailored approach to managing cardiogenic shock and temporary mechanical circulatory support (tMCS). We also outline specific mobilization strategies for patients with different tMCS devices and configurations, which can be enabled by this tailored approach to cardiogenic shock management.
Safe and effective mobilization of patients with cardiogenic shock receiving tMCS can be accomplished. Appropriate patient selection, tailored device management, and dynamic multidisciplinary approaches to mobilization are critical to success. Cardiogenic shock is a heterogeneous condition characterized by end-organ dysfunction due to hypoperfusion and low cardiac output. Temporary mechanical circulatory support (tMCS) is an increasingly valuable tool in managing these patients, with various devices and configurations available. Critically ill patients receiving tMCS are at risk for complications and deconditioning associated with prolonged bed rest, making it essential to implement strategies that promote mobility when feasible. We advocate for a tailored approach to the selection and management of tMCS in patients with cardiogenic shock. This approach focuses on the early identification of patients who may benefit from tMCS before further deterioration, alongside the selection of devices that provide ventricular-specific support and facilitate upper-body cannulation to enhance mobilization while also considering patients' potential exit strategies from tMCS. Understanding this approach is vital to appropriately facilitating safe and effective mobilization.
本文讨论了一种针对心源性休克和临时机械循环支持（tMCS）的个性化管理方法。我们还概述了针对使用不同tMCS设备和配置的患者的具体活动策略，这种心源性休克管理的个性化方法可以实现这些策略。
对于接受tMCS的心源性休克患者，可以实现安全有效的活动。合适的患者选择、个性化的设备管理以及动态多学科的活动方法是成功的关键。心源性休克是一种异质性疾病，其特征是由于灌注不足和心输出量低导致的器官功能障碍。临时机械循环支持（tMCS）在管理这些患者方面是一种越来越有价值的工具，有多种设备和配置可供选择。接受tMCS的重症患者存在与长期卧床相关的并发症和身体机能减退的风险，因此在可行时实施促进活动的策略至关重要。我们提倡采用个性化方法来选择和管理心源性休克患者的tMCS。这种方法侧重于在病情进一步恶化之前尽早识别可能从tMCS中获益的患者，同时选择提供心室特异性支持并便于上身插管以增强活动能力的设备，同时还要考虑患者脱离tMCS的潜在策略。理解这种方法对于适当促进安全有效的活动至关重要。
