Observational data suggest that the subset of patients with heart failure related CS (HF-CS) now predominate critical care admissions for CS. There are no dedicated HF-CS randomised control trials completed to date which reliably inform clinical practice or clinical guidelines. We sought to identify aspects of HF-CS care where both consensus and uncertainty may exist to guide clinical practice and future clinical trial design, with a specific focus on HF-CS due to acute decompensated chronic HF. A 16-person multi-disciplinary panel comprising of international experts was assembled. A modified RAND/University of California, Los Angeles, appropriateness methodology was used. A survey comprising of 34 statements was completed. Participants anonymously rated the appropriateness of each statement on a scale of 1 to 9 (1–3 as inappropriate, 4–6 as uncertain and as 7–9 appropriate). Of the 34 statements, 20 were rated as appropriate and 14 were rated as inappropriate. Uncertainty existed across all three domains: the initial assessment and management of HF-CS; escalation to temporary Mechanical Circulatory Support (tMCS); and weaning from tMCS in HF-CS. Significant disagreement between experts (deemed present when the disagreement index exceeded 1) was only identified when deliberating the utility of thoracic ultrasound in the immediate management of HF-CS. This study has highlighted several areas of practice where large-scale prospective registries and clinical trials in the HF-CS population are urgently needed to reliably inform clinical practice and the synthesis of future societal HF-CS guidelines.

中文翻译：

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心力衰竭心源性休克的治疗：国际兰德适当性小组

观察数据表明，心力衰竭相关 CS (HF-CS) 患者目前在重症监护室因 CS 入院的患者中占主导地位。迄今为止，尚未完成专门的 HF-CS 随机对照试验来可靠地为临床实践或临床指南提供信息。我们试图确定 HF-CS 护理中可能存在共识和不确定性的方面，以指导临床实践和未来的临床试验设计，特别关注因急性失代偿性慢性心力衰竭引起的 HF-CS。组建了一个由 16 人组成的多学科专家小组，其中包括国际专家。使用了经过修改的兰德公司/加州大学洛杉矶分校的适当性方法。一项包含 34 份陈述的调查已完成。参与者以 1 到 9 的等级匿名评价每项陈述的适当性（1-3 为不适当，4-6 为不确定，7-9 为适当）。在 34 条陈述中，20 条被评为适当，14 条被评为不适当。所有三个领域都存在不确定性：HF-CS 的初步评估和管理；升级为临时机械循环支持 (tMCS)； HF-CS 中的 tMCS 脱机。仅在考虑胸部超声在 HF-CS 的直接治疗中的效用时，才发现专家之间存在重大分歧（当分歧指数超过 1 时视为存在）。这项研究强调了迫切需要在 HF-CS 人群中进行大规模前瞻性登记和临床试验的几个实践领域，以便可靠地为临床实践和未来社会 HF-CS 指南的综合提供信息。