BACKGROUND Temporary mechanical circulatory support (MCS) devices provide hemodynamic assistance for shock refractory to pharmacological treatment. Most registries have focused on single devices or specific etiologies of shock, limiting data regarding overall practice patterns with temporary MCS in cardiac intensive care units. METHODS The CCCTN (Critical Care Cardiology Trials Network) is a multicenter network of tertiary CICUs in North America. Between September 2017 and September 2018, each center (n=16) contributed a 2-month snapshot of consecutive medical CICU admissions. RESULTS Of the 270 admissions using temporary MCS, 33% had acute myocardial infarction-related cardiogenic shock (CS), 31% had CS not related to acute myocardial infarction, 11% had mixed shock, and 22% had an indication other than shock. Among all 585 admissions with CS or mixed shock, 34% used temporary MCS during the CICU stay with substantial variation between centers (range: 17%-50%). The most common temporary MCS devices were intraaortic balloon pumps (72%), Impella (17%), and veno-arterial extracorporeal membrane oxygenation (11%), although intraaortic balloon pump use also varied between centers (range: 40%-100%). Patients managed with intraaortic balloon pump versus other forms of MCS (advanced MCS) had lower Sequential Organ Failure Assessment scores and less severe metabolic derangements. Illness severity was similar at high- versus low-MCS utilizing centers and at centers with more advanced MCS use. CONCLUSIONS There is wide variation in the use of temporary MCS among patients with shock in tertiary CICUs. While hospital-level variation in temporary MCS device selection is not explained by differences in illness severity, patient-level variation appears to be related, at least in part, to illness severity.

中文翻译：

---

重症监护心脏病学试验网络（CCCTN）注册表中的休克临时机械循环支持的临床实践模式。

背景技术临时机械循环支持（MCS）装置为药理学治疗难治性休克提供了血流动力学辅助。大多数注册机构只关注单一设备或特定的休克病因，从而限制了有关重症监护病房中使用临时MCS的整体实践模式的数据。方法CCCTN（重症监护心脏病学试验网络）是北美的第三次重症监护病房的多中心网络。在2017年9月至2018年9月之间，每个中心（n = 16）为连续两个月的CICU医疗收治提供了2个月的快照。结果在使用临时MCS的270例入院患者中，有33％患有急性心肌梗死相关的心源性休克（CS），有31％的CS与急性心肌梗死无关，有11％的有混合性休克，有22％的症状是非休克。在所有有CS或混合性休克的585例入院中，有34％的患者在CICU期间使用了临时MCS，各中心之间存在较大差异（范围：17％-50％）。最常见的临时MCS装置是主动脉内球囊泵（72％），Impella（17％）和静脉-动脉体外膜氧合（11％），尽管主动脉内球囊泵的使用在各中心之间也有所不同（范围：40％-100％ ）。与其他形式的MCS（高级MCS）相比，主动脉内球囊泵治疗的患者序贯器官衰竭评估得分较低，代谢紊乱严重程度较轻。在高MCS使用中心和低MCS使用中心以及使用更高级MCS的中心，疾病的严重程度相似。结论三级重症监护病房中休克患者使用临时MCS的差异很大。