Title: To Pump or not to Pump?
題目：是用泵還是不用泵？
Author 作者: Haney Mallemat

Intra-aortic balloon pumps (IABP) are devices that provide hemodynamic support during cardiogenic shock; the balloon inflates during diastole (improving coronary artery perfusion) and deflates during systole (reducing afterload and improving systemic perfusion).
主動脈內氣囊反搏（IABP）是在心源性休克用來提供血液動力學支持的設備。氣囊在舒張期充氣（改善冠狀動脈灌注），在收縮期放氣（減輕后負荷，以改善全身灌注）。
Several guidelines recommend placement of an IABP for patients in cardiogenic shock secondary to acute myocardial infarction (AMI), if early revascularization (e.g., CABG) is planned (Class I recommendation). Data behind this recommendation, however, is limited.
有幾個臨床指南都建議IABP在右急性心肌梗塞造成的心源性休克的使用，以過度到早期血管再通（如冠狀動脈搭橋等，一級建議）。但是，支持這一建議的數據是有限的。
The IABP-SHOCK II trial was a randomized, multi-center, open-label study that enrolled 600 patients (598 in the analysis) with cardiogenic shock secondary to AMI (STEMI or NSTEMI). Patients were randomized to the control group (receiving standard therapy; N=298) or the experimental group (receiving IABP; N=300).
主動脈內氣囊反搏-休克（IABP－SHOCK）II是一個隨機的，多中心的，開放標簽的臨床研究，包括了600個（598個用于分析）由急性心肌梗塞（ST段升高或不升高）造成的心源性休克的病人。病人隨機的分成對照組（接受標準治療，298人）或實驗組（接受IABP，300人）。
No significant difference was found between groups with respect to 30-day mortality (primary end-point), secondary end-points (e.g., time to hemodynamic stabilization, renal function, lactate levels, etc.), or complications (e.g., major bleeding, peripheral ischemic complications, etc.).
結果顯示在30天死亡率（主要指標）或到血液動力學穩定時間，腎功，乳酸水平（次要指標），或合并癥（大出血，末梢缺血）方面兩組之間沒有明顯差別。
Bottom line: Perhaps it is time to reassess the approach to cardiogenic shock secondary to AMI when early revascularization is planned. At this time consultation with local expertise is recommended.
要點：對于有計劃要接受早期在灌注治療的急性心肌梗塞心源性休克的病人的搶救方案要急性從新的評估。到目前為止，還是要聽取專家的意見。

References 參考文獻
Thiele, H. et al. Intra aortic balloon support for myocardial infarction with cardiogenic shock. NEJM 2012 Oct 4;367(14):1287-1296.