Grant Michael C, Brudney Charles Scott, Hernandez-Montfort Jaime, Ibekwe Stephanie O, Rea Amanda, Stoppe Christian, Zarbock Alexander, Shaw Andrew D, Engelman Daniel T, Kanwar Manreet K
Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
Department of Anesthesiology, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Ann Thorac Surg. 2025 Aug;120(2):202-212. doi: 10.1016/j.athoracsur.2025.01.040. Epub 2025 Apr 3.
The management of patients with cardiogenic shock (CS) is complex and resource intensive, particularly given the recent surge in temporary mechanical circulatory support (tMCS) devices. This document was created to establish an approach to the assessment of CS to provide early and targeted therapies, including tMCS.
An interdisciplinary, international panel of experts, using a structured appraisal of the literature and a modified Delphi method, derived consensus regarding the assessment of CS based on pathophysiologic severity, etiology, and phenotypic clustering to guide escalation of care as well as identify those patients who might benefit from tMCS.
Key principles included early and continuous assessment for the evolution of shock severity to guide the escalation of care as well as establishment of the cause of CS to facilitate triage and assignment of initial therapies. Phenotypic clustering is complementary and aids in prognosis. tMCS provides the greatest benefit in CS for relief of congestion refractory to medical therapy, ideally when initiated before the development of organ injury. The use of tMCS should be preceded by an interdisciplinary discussion as part of the informed consent process to establish therapeutic goals, including exit strategies.
Based on the available literature and expert consensus, there is an opportunity to further standardize the approach to CS, including characterization based on the severity of the shock state, etiology, and further enhancement by phenotyping. Monitoring, early triage, and timely escalation of care, including the targeted initiation of tMCS, can minimize organ injury and in-hospital mortality.
心源性休克（CS）患者的管理复杂且资源消耗大，尤其是考虑到近期临时机械循环支持（tMCS）设备的激增。本文件旨在确立一种评估CS的方法，以提供早期和有针对性的治疗，包括tMCS。
一个跨学科的国际专家小组，采用文献的结构化评估和改良的德尔菲法，基于病理生理严重程度、病因和表型聚类对CS评估达成共识，以指导治疗升级，并确定可能从tMCS中获益的患者。
关键原则包括对休克严重程度的演变进行早期和持续评估，以指导治疗升级，以及确定CS的病因，以促进分诊和初始治疗的分配。表型聚类是互补的，有助于预后。tMCS在CS中对缓解药物治疗难治的充血最有益，理想情况下是在器官损伤发生之前启动。在使用tMCS之前，应进行跨学科讨论，作为知情同意过程的一部分，以确立治疗目标，包括撤离策略。
基于现有文献和专家共识，有机会进一步规范CS的治疗方法，包括根据休克状态的严重程度、病因进行特征描述，并通过表型分析进一步强化。监测、早期分诊和及时的治疗升级，包括有针对性地启动tMCS，可以将器官损伤和院内死亡率降至最低。
