Left Ventricular Unloading in Combination with VA-ECMO for the Treatment of Cardiogenic Shock: Mechanisms, Methods, and Future Directions

心源性休克是一种由心脏泵功能衰竭导致的高死亡率临床综合征，其治疗始终是临床重大挑战。静脉–动脉体外膜肺氧合(VA-ECMO)通过提供循环与呼吸支持，显著改善患者血流动力学及氧合状态，但其应用可能导致左心室后负荷增加，加剧心肌缺血与肺水肿。左心室卸负荷通过降低左心室前、后负荷，减少心肌氧耗，促进功能恢复，与VA-ECMO联合应用可协同提升疗效。本文系统综述了心源性休克的病理生理机制、VA-ECMO与左心室卸负荷的作用机制，并探讨了主动脉内球囊反搏、经皮左室辅助装置、房间隔分流及外科手术等卸负荷方法的临床效果与局限性。现有研究表明，联合治疗可改善患者生存率及预后，但适应证选择、装置优化及并发症管理仍是关键挑战。未来需通过个体化策略、新型装置研发及多中心随机对照研究，进一步明确最佳治疗方案，为临床实践提供循证依据。Cardiogenic shock is a clinical syndrome with high mortality caused by the failure of cardiac pump function, and its treatment has always a major clinical challenge. Venous-arterial extracorporeal membrane oxygenation (VA-ECMO) significantly improves patients’ hemodynamics and oxygenation by circulatory and respiratory support, but its application may lead to increased afterload of the left ventricle, exacerbating myocardial ischemia and pulmonary edema, ventricular unloading, by reducing the pre- and afterload of the left ventricle, reducing myocardial oxygen consumption, and promoting functional recovery, can synerg improve the efficacy when used in combination with VA-ECMO. This article systematically reviewed the pathophysiological mechanisms of cardiogenic shock, the mechanisms of action of VAECMO and left ventricular unloading, and explored the clinical effects and limitations of unloading methods such as intra-aortic balloon counterpulsation, percutaneous left ventricular assist device, atrial septal shunt, and surgical treatment. Existing studies have shown that combined treatment can improve survival rate and prognosis, but the selection of indications, device optimization, and complication management remain key challenges. In the future, it is necessary to further clarify the best treatment plan through personalized strategies, the development of new devices, and multicenter randomized controlled trials, and to provide evidence-based basis for clinical practice.