Temporary mechanical circulatory support as well as multidisciplinary team approach in a regional care organization might improve survival of cardiogenic shock. No study has evaluated the relative effect of each temporary mechanical circulatory support on mortality in the context of a regional network. Prospective observational data were retrieved from patients consecutively admitted with cardiogenic shock to the intensive care units in 3 centres organized into a regional cardiac assistance network. Temporary mechanical circulatory support indication was decided by a heart team, based on the initial shock severity or if shock was refractory to medical treatment within 24 hours of admission. A propensity score for circulatory support use was used as an adjustment co-variable to emulate a target trial. The primary endpoint was in-hospital mortality. 246 patients were included in the study (median age 59.5 years, 71.9% male): 121 received early mechanical assistance. The main etiologies were acute myocardial infraction (46.8%) and decompensated heart failure (27.2%). Patients who received early mechanical assistance had more severe conditions than other patients. Their crude in-hospital mortality was 38% and 22.4% in other patients but adjusted in-hospital mortality was not different (hazard ratio 0.91, 95%CI:0.65-1.26). Patients with mechanical assistance had a higher rate of complications than others with longer ICU and hospital stays. In the conditions of a cardiac assistance regional network, in-hospital mortality was not improved by early mechanical assistance implantation. A high incidence of complications of temporary mechanical circulatory support may have jeopardized its potential benefit.

中文翻译：

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心源性休克的早期临时机械循环支持：来自区域心脏援助网络的真实数据

区域护理组织中的临时机械循环支持以及多学科团队方法可能会改善心源性休克的生存率。尚无研究评估区域网络中每种临时机械循环支持对死亡率的相对影响。前瞻性观察数据取自因心源性休克连续入住 3 个中心重症监护病房的患者，这些中心组成了区域心脏援助网络。临时机械循环支持指征由心脏团队根据最初休克的严重程度或入院 24 小时内的药物治疗是否难以缓解休克来决定。使用循环支持的倾向评分用作调整协变量来模拟目标试验。主要终点是院内死亡率。该研究纳入了 246 名患者（中位年龄 59.5 岁，71.9% 为男性）：其中 121 名患者接受了早期机械辅助。主要病因是急性心肌梗死（46.8%）和失代偿性心力衰竭（27.2%）。早期接受机械辅助的患者比其他患者病情更严重。其他患者的粗住院死亡率分别为 38% 和 22.4%，但调整后的院内死亡率没有差异（风险比 0.91，95%CI：0.65-1.26）。接受机械辅助的患者比 ICU 和住院时间较长的患者并发症发生率更高。在心脏辅助区域网络的条件下，早期机械辅助植入并没有改善院内死亡率。临时机械循环支持并发症的高发生率可能会损害其潜在益处。