Clinical Efficacy of ECMO in the Treatment of AMI Complicated with Refractory CS

Abstract

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.