Background:Current practice in cardiogenic shock is guided by expert opinion in guidelines and scientific statements from professional societies with limited high quality randomized trial data to inform optimal patient management. An international panel conducted a modified Delphi process with the intent of identifying aspects of cardiogenic shock care where there was uncertainty regarding optimal patient management.Methods:An 18-person multidisciplinary panel comprising international experts was convened. A modified RAND/University of California Los Angeles appropriateness methodology was used. A survey comprising 70 statements was completed. Participants anonymously rated the appropriateness of each statement on a scale of 1 to 9: 1 to 3 inappropriate, 4 to 6 uncertain, and 7 to 9 appropriate. A summary of the results was discussed as a group, and the survey was iterated and completed again before final analysis.Results:There was broad alignment with current international guidelines and consensus statements. Overall, 44 statements were rated as appropriate, 19 as uncertain, and 7 as inappropriate. There was no disagreement with a disagreement index <1 for all statements. Routine fluid administration was deemed to be inappropriate. Areas of uncertainty focused panel on pre-PCI interventions, the use of right heart catheterization to guide management, routine use of left ventricular unloading strategies, and markers of futility when considering escalation to mechanical circulatory support.Conclusions:While there was broad alignment with current guidance, an expert panel found several aspects of care where there was clinical equipoise, further highlighting the need for randomized controlled trials to better guide patient management and decision making in cardiogenic shock.

中文翻译：

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心源性休克的当代管理：兰德适当性小组方法

背景：目前心源性休克的实践以指南中的专家意见和来自专业协会的科学声明为指导，并以有限的高质量随机试验数据为最佳患者管理提供信息。一个国际小组进行了改进的 Delphi 过程，目的是确定在最佳患者管理方面存在不确定性的心源性休克护理方面。方法：召集了一个由国际专家组成的 18 人多学科小组。使用了经过修改的兰德公司/加州大学洛杉矶分校适当性方法。完成了一项包含 70 份陈述的调查。参与者以 1 到 9 的等级匿名对每个陈述的适当性进行评分：1 到 3 不适当，4 到 6 不确定，7 到 9 适当。结果总结作为一个小组进行了讨论，并在最终分析之前重复并再次完成调查。结果：与当前的国际指南和共识声明有广泛的一致性。总体而言，44 项陈述被评为适当，19 项不确定，7 项不适当。对于所有陈述，不存在分歧指数 <1 的分歧。常规输液被认为是不合适的。不确定领域集中在 PCI 前干预、使用右心导管指导管理、常规使用左心室卸载策略以及考虑升级到机械循环支持时的无效标记。结论：虽然与当前的广泛一致在指导下，一个专家小组发现了临床平衡的几个护理方面，