Cardiogenic shock (CS) remains the leading cause of death in patients hospitalised with acute myocardial infarction with mortality as high as 40%–50% prior to hospital discharge. The failure of inotropic therapy to maintain adequate perfusion and to prevent irreversible end-organ failure has led to attempts to improve outcomes by mechanical circulatory support (MCS) devices. Axial flow ventricular assist devices, namely Impella, are an attractive therapeutic option due to their positive haemodynamic benefits and ease of use. Despite clear beneficial haemodynamic effects, which should significantly impact on the pathophysiology of CS, there are currently no clear data to support their use in the reduction of clinical end points such as cardiac death. This review summarises and critically evaluates the current scientific evidence for the use of axial flow ventricular assist devices and highlights gaps in our understanding. Given such gaps, a consensus multidisciplinary approach, predicated on emphasising timely diagnosis and appropriate use of MCS, is vital to ensure that the right patient is paired with the right device at the right time.

中文翻译：

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心源性休克并发急性心肌梗死的轴流心室辅助装置

心源性休克 (CS) 仍然是急性心肌梗死住院患者的主要死因，出院前死亡率高达 40%–50%。正性肌力治疗未能维持足够的灌注和防止不可逆的终末器官衰竭，导致尝试通过机械循环支持 (MCS) 装置改善结果。轴流心室辅助装置，即 Impella，由于其积极的血液动力学益处和易用性，是一种有吸引力的治疗选择。尽管明显有益的血液动力学效应应该对 CS 的病理生理学产生显着影响，但目前没有明确的数据支持它们用于减少临床终点，如心源性死亡。本综述总结并批判性地评估了当前使用轴流心室辅助装置的科学证据，并突出了我们理解中的差距。鉴于存在这些差距，以强调及时诊断和适当使用 MCS 为基础的多学科共识方法对于确保正确的患者在正确的时间与正确的设备配对至关重要。