BackgroundThe safety and feasibility of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) as mechanical circulatory support in high-risk percutaneous coronary intervention (HR-PCI) remain unclear.MethodsThis retrospective study included patients with complex and high-risk coronary artery disease who underwent elective PCI with VA-ECMO support pre-operatively during March 2019–December 2020. Rates of VA-ECMO-related complications, complications during PCI, death, myocardial infarction, and stroke during hospitalisation and 1-year post-operatively were analysed.ResultsOverall, 36 patients (average age: 63.6 ± 8.9 years) underwent PCI. The average duration of VA-ECMO support was 12.5 (range, 3.0–26.3) h. Intra-aortic balloon pump counterpulsation was used in 44.4% of patients. The SYNTAX score was 34.6 ± 8.4 pre-operatively and 10.8 ± 8.8 post-operatively (P < 0.001). Intraoperative complications included pericardial tamponade (N = 2, 5.6%), acute left-sided heart failure (N = 1, 2.8%), malignant arrhythmia requiring electrocardioversion (N = 2, 5.6%), and no deaths. Blood haemoglobin levels before PCI and 24 h after VA-ECMO withdrawal were 145.4 ± 20.2 g/L and 105.7 ± 21.7 g/L, respectively (P < 0.001). Outcomes during hospitalisation included death (N = 1, 2.8%), stroke (N = 1, 2.8%), lower limb ischaemia (N = 2, 5.6%), lower limb deep venous thrombosis (N = 1, 2.8%), cannulation site haematoma (N = 2, 5.6%), acute renal injury (N = 2, 5.6%), bacteraemia (N = 2, 5.6%), bleeding requiring blood transfusion (N = 5, 13.9%), and no recurrent myocardial infarctions. Within 1 year post-operatively, two patients (5.6%) were hospitalised for heart failure.ConclusionsVeno-arterial extracorporeal membrane oxygenation mechanical circulation support during HR-PCI is a safe and feasible strategy for achieving revascularisation in complex and high-risk coronary artery lesions. VA-ECMO-related complications require special attention.

BackgroundThis study aimed to summarize and analyse the risk factors, clinical features, as well as prevention and treatment of limb ischemia complications in patients on veno-arterial extracorporeal membrane oxygenation (V-A ECMO).MethodsWe retrospectively analyzed 179 adult patients who had undergone V-A ECMO support in the Cardiac Care Unit of the First Hospital of Lanzhou University between March 2019 and December 2021. Patients were divided into the limb ischemia group (LI group) and the non-limb ischemia group (nLI group) according to whether limb ischemia occurred on the ipsilateral side of femoral artery cannulation. In the LI group, patients were salvaged with a distal perfusion cannula (DPC) according to each patient's clinical conditions. The baseline data and ECMO data were compared between the two groups, and risk factors for limb ischemia complications were screened using multiple logistic regression analysis.ResultsOverall, 19 patients (10.6%) had limb ischemia complications, of which 5 (2.8%) were improved after medication adjustment, 12 (8.4%) were salvaged with a DPC, and 2 had undergone surgical intervention. There were significant differences in terms of Extracorporeal Cardiopulmonary Resuscitation (ECPR), Intra-aortic balloon pump (IABP), peak vasoactive-inotropic score (VIS) within 24 h after ECMO (VIS-max), Left ventricular ejection fraction (LVEF), weaning from ECMO, and discharge rate between the two groups. ECPR, IABP, and VIS-max in the LI group were significantly higher than those in the nLI group, whereas weaning from ECMO, discharge rate, and LVEF were significantly lower in the LI group compared to those in the nLI group. Furthermore, multiple logistic regression analysis revealed that diabetes [odds ratio (OR) = 4.338, 95% confidence interval (CI): 1.193–15.772, P = 0.026], IABP (OR = 1.526, 95% CI: 1.038–22.026, P = 0.049) and VIS-max (OR = 1.054, 95% CI: 1.024–1.085, P < 0.001) were independent risk factors for limb ischemia complications in patients who underwent V-A ECMO.ConclusionDiabetes, prevalence of IABP and VIS-max value in analyzed groups were independent risk factors for predicting limb ischemia complications in patients who underwent V-A ECMO. The cannulation strategy should be optimized during the establishment of V-A ECMO, and limb ischemia should be systematically evaluated after ECMO establishment. A DPC can be used as a salvage intervention for the complications of critical limb ischemia.

Objective: The aim of this single-centre retrospective study was to investigate the efficacy of extracorporeal membrane oxygenation (ECMO) in the treatment of acute myocardial infarction (AMI) complicated by refractory cardiogenic shock (CS). Background: While mechanical circulatory support (MCS) devices are widely used in reperfusion therapy, no significant reduction in mortality has been observed. ECMO is a rescue tool for patients refractory CS, with a paucity of data evaluating its efficacy in the treatment of AMI complicated with refractory CS. Methods: All consecutively enrolled patients with AMI and refractory CS admitted to the First Hospital of Lanzhou University from July 1, 2015, to October 31, 2021, were enrolled. According to the MCS device, the patients were divided into the ECMO and IABP groups. The primary outcome of our study was 30-day mortality. Secondary outcomes included perioperative mortality, 90-day mortality, renal failure requiring CRRT, life-threatening bleeding, moderate bleeding, ischaemic complications, and bacteremia. Results: A total of 81 patients, with a mean age of 62 ± 10 years, were included, 79% of them were males. Forty-four patients (54.3%) were included in the IABP group, and 37 (45.7%) were included in the ECMO group. The average lactate level was 7.05 ± 3.56 mmol/L. A total of 72.0% of patients had multivessel coronary artery disease (CAD). Compared with IABP, ECMO led to lower 30-day mortality (68.2% vs. 43.2%, χ2=8.423, P=0.004) and perioperative mortality rates (20.0% vs. 0.00%, χ2=5.877, P=0.015) but prolonged the patient's CCU (10.0 vs. 3.5, p < 0.001) and total hospital stay (13 vs. 4, p < 0.001). In the subgroup analysis of multivessel CAD, the 30-day mortality rate in the ECMO group who underwent immediate multivessel PCI was significantly lower than that in those who initially underwent PCI of the culprit lesion only (21.4% vs. 61.5%, χ2=4.402, P=0.036). Conclusion: ECMO can significantly reduce the risk of 30-day mortality and does not increase the risk of serious complications. In addition, immediate multivessel PCI with ECMO can significantly reduce 30-day mortality in patients with multivessel CAD.