| Abstract | Zatajivanje srca je složeni klinički sindrom karakteriziran specifičnim simptomima i
znakovima smanjenog minutnog volumena te kongestije organa uzrokovanih
strukturnim i/ili funkcijskim poremećajima srca. Prevalencija ZS iznosi 1-2% i seže na
više od 10% među populacijom starijom od 70 godina. Procjenjuje se da će ukupan
broj oboljelih od ZS do 2030. godine porasti za 50%. Boljim razumijevanjem
patofiziologije kroničnog zatajivanja srca te napretkom farmakološke terapije dolazi do
značajnog poboljšanja preživljenja i kvalitete života oboljelih, kontrolom i ublažavanjem
simptoma bolesti. Kada govorimo o akutnom zatajivanju srca (AZS), posebice o
najizazovnijoj kliničkoj prezentaciji istog – kardiogenom šoku, konvencionalna i
farmakološka terapija ponekad neće biti dovoljna. Refrakternost na farmakološku
terapiju te ostalu dostupnu terapiju kao i visoke stope mortaliteta u AZS dovele su do
potrebe za razvojem mehaničkih cirkulacijskih potpora koje volumno rasterećuju srce
te osiguravaju optimalni hemodinamski status. Privremena mehanička cirkulacijska
potpora (MCS) naziv je koji se odnosi na skupinu uređaja koji se koriste u kratkom
vremenskom periodu najčešće do 30 dana. Riječ je o nekoliko parakorporalnih pumpi
koje postavljene kirurški ili perkutano pružaju potporu lijevoj i/ili desnoj strani srca. Ne
predstavljaju trajno rješenje već, u slučaju akutnog zatajivanja srca, most su do
oporavka, ugradnje trajne mehaničke potpore srcu ili do transplantacije srca.
Implementacija MCS-a uz standardnu terapiju u liječenju kardiogenog šoka dozvoljava
vrijeme za otkrivanje i djelovanje na etiologiju AZS. Medicinske sestre i tehničari
izravno skrbe o bolesnicima na MCS-u stoga je nužno razumijevanje njihovog
hemodinamskog učinka, poznavanje glavnih sastavnica pojedine crpke kao i razvoja
potencijalnih komplikacija. U Republici Hrvatskoj najčešće susrećemo s
intraaortalnom balon pumpom, perkutanom transvalvularnom crpkom za potporu lijeve
klijetke (Impella) i izvantjelesnom membranskom oksigenacijom (ECMO), te su iste
izdvojene u ovom radu. |
| Abstract (english) | Heart failure is a complex clinical syndrome characterized by specific symptoms and
signs of reduced cardiac output and organ congestion caused by structural and/or
functional disorders of the heart. The prevalence of heart failure is 1-2% and affects
more than 10% of the population older than 70 years of age. It is estimated that the
total number of patients with heart failure will increase by 50% by 2030. By better
understanding of the pathophysiology of chronic heart failure and the progress of
pharmacological therapy, there is a significant improvement in the survival and quality
of life of patients, as well as by controlling and alleviating the symptoms of the disease.
When it comes to acute heart failure, especially its most challenging clinical
presentation – cardiogenic shock, conventional and pharmacological therapy is
sometimes not enough. Refractoriness to pharmacological therapy and other available
therapy, as well as high mortality rates in acute heart failure, have led to the need to
develop mechanical circulatory supports that unload the heart and ensure optimal
hemodynamic status. Temporary Mechanical Circulatory Support (MCS) refers to a
group of devices that are used for a short period of time, usually up to 30 days.
Specifically, these are several paracorporeal pumps that are placed surgically or
percutaneously to support the left and/or right side of the heart. However, they are not
a permanent solution but in the case of acute heart failure, they represent a bridge to
recovery, the implantation of durable mechanical support for the heart or to heart
transplantation. The implementation of MCS with standard therapy in the treatment of
cardiogenic shock provides time to detect and act on the etiology of acute heart failure.
Nurses and technicians directly care for patients on MCS, therefore, it is necessary to
understand their hemodynamic effect, to know the main components of each pump as
well as to be familiar with the development of potential complications. In the Republic
of Croatia, we most often encounter the intra-aortic balloon pump, percutaneous
transvalvular left ventricular support pump (Impella) and extracorporeal membrane
oxygenation (ECMO), and these are all further described in this paper. |
