Door-to-VAD time: an expedient management strategy for cardiogenic shock

作者：Cabuay Barry; Hryniewicz Katarzyna; Sun Benjamin; Feldman David^*

来源：Current Opinion in Cardiology, 2010, 25(3): 249-252.

DOI：10.1097/HCO.0b013e328338a58b

• heart failure
• mechanical support
• shock
• VAD
• ventricular assist device

Purpose of review
Emerging devices are now providing full hemodynamic support and may improve survival in patients who present with cardiogenic shock. This manuscript will present the framework strategy for utilizing current advancements in temporary device therapy for acutely decompensated patients with cardiogenic shock, as a stabilizing bridge-to-decision (BTD) modality. We identify criteria for the clinical presentation of cardiogenic shock and a list of factors that suggest inferior outcomes.
Recent findings
Cardiogenic shock continues to be associated with significant morbidity and mortality. The observed poor outcomes are usually impacted by delayed recognition and limited pharmacologic options. Initial therapeutic responses are often temporarily successful, but fail to adequately resuscitate many patients who ultimately die of multiorgan system or septic deaths.
Summary
We will describe essential clinical components to assist in identifying such patients for short-term circulatory support as a BTD for advanced durable ventricular assist devices. Improved outcomes of patients with cardiogenic shock may be achieved by both early clinical recognition and early strategic implementation of sustainable temporary circulatory support.

• 出版日期2010-5