Efficacy of veno-arterial extracorporeal membrane oxygenation in acute myocardial infarction with cardiogenic shock

Kim, Hyungtae; Lim, Sang-Hyun; Hong, Jung-Wan; Hong, Yongseok; Lee, Cheol Joo; Jung, Joonho; Yu, Saehwan

doi:10.1016/j.resuscitation.2012.01.037

Cited by 102 publications

(70 citation statements)

References 19 publications

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“…In a single-centre study in a population with deep CS of a heterogenous aetiology, the majority of 68 patients who were successfully weaned from ECMO were discharged alive. In-hospital mortality in the STEMI subgroup was 40.5% [36], which was also confirmed in a small STEMI-only oriented study on 27 subjects (37% 30-day mortality in those successfully weaned from ECMO) [37] and in another one on 33 patients (1-year mortality 36.4% in patients treated with ECMO and IABP vs. 76% in those without ECMO; p < 0.001) [38]. Although these data are encouraging, better survival was assigned for successful weaning from ECMO.…”

Section: Novel Devices and Areas Of Future Researchsupporting

confidence: 66%

The management of patients with cardiogenic shock

Sadowski¹,

Janion−Sadowska²

2017

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Cardiogenic shock is a life-threatening condition with a very poor prognosis. Many disorders may contribute to the development of shock. Of them, acute myocardial infarction is the main culprit. Despite tremendous progress in the field of interventional cardiology, in-hospital and long-term mortality still exceeds 50%. Data from large controlled trials on cardiogenic shock are scarce due to ethical reasons. Nevertheless, there is a chance for acceptable long-term survival in patients treated aggressively. The aim of this review is to summarise the key points of differential diagnosis and to emphasise that in most cases of shock due to acute myocardial infarction primary coronary intervention is the treatment of choice. StreszczenieWstrząs kardiogenny jest stanem zagrożenia życia o bardzo złym rokowaniu. Wiele sytuacji klinicznych przyczynia się do rozwoju wstrząsu, ale ostry zawał serca stanowi najczęstszą przyczynę. Pomimo olbrzymiego postępu w kardiologii interwencyjnej śmiertelność szpitalna i długoterminowa nadal przekracza 50%. Z powodów etycznych nie dysponujemy danymi z kontrolowanych badań klinicznych. Niemniej agresywne leczenie stwarza szansę na uzyskanie akceptowalnego poziomu śmier-telności w tej grupie chorych. Celem pracy jest próba podsumowania najważniejszych elementów diagnostyki różnicowej oraz wykazanie, że pilna rewaskularyzacja za pomocą angioplastyki wieńcowej jest leczeniem z wyboru w większości przypadków.

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Section: Novel Devices and Areas Of Future Researchsupporting

confidence: 66%

The management of patients with cardiogenic shock

Sadowski¹,

Janion−Sadowska²

2017

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“…23,24 Previously reported discharge rates in selected small case studies were ≈30 to 40%. 25,26 In this series, coronary patients requiring ECMO had discharge rates of 35% regardless of whether CABG was performed. Despite better results in the CABG group at 30 days, both the CABG and MI/CS patients had similarly poor long-term survival rates.…”

Section: Discussionmentioning

confidence: 86%

Survival Analysis After Extracorporeal Membrane Oxygenation in Critically Ill Adults

et al. 2016

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As a result of many "miraculous" experiences, intensive care facilities everywhere in Taiwan are adopting ECMO technology. 13,14 The Taiwan National Health Insurance (NHI) initiated reimbursement for the high costs of ECMO therapy in 2002, further supporting its rapidly expanding implementation in the years since. The criteria for instituting ECMO in adult patients included cardiogenic shock of various origins, respiratory failure (defined as Pao 2 <60 mm Hg under 100% Fio 2 , CO 2 retention, or a bridge to lung transplantation) resulting from infectious or noninfectious processes, airway injury, and hypothermia (core temperature ≤30°C).15 ECMO is most used as a last resort for patients with severe refractory shock. The Taiwan NHI Background-Extracorporeal membrane oxygenation (ECMO) provides circulatory and respiratory support for patients with severe acute cardiopulmonary failure. The objective of this study was to examine the survival outcomes for patients who received ECMO. Methods and Results-Adult patients who received ECMO from September 1, 2002, to December 31, 2012 from the Taiwan National Health Insurance Database associated with coronary artery bypass graft surgery, myocardial infarction/cardiogenic shock, injury, and infection/septic shock. A Cox regression model was used to determine hazard ratios and to compare 30-day and 1-year survival rates with the myocardial infarction/cardiogenic shock group used as the reference. The mean±SD age of the 4227-patient cohort was 57±17 years, and 72% were male. The overall mortalities were 59.8% and 76.5% at 1 month and 1 year. Survival statistics deteriorated sharply when ECMO was required for >3 days. Acute (30-day) survival was more favorable in the infection/septic shock (n=1076; hazard ratio, 0.61; 95% confidence interval, 0.55-0.67), coronary artery bypass graft surgery (n=1077; hazard ratio, 0.68; 95% confidence interval, 0.61-0.75), and injury (n=369, hazard ratio, 0.82; 95% confidence interval, 0.70-0.95) groups. The extended survival rapidly approached an asymptote near 20% for the infection/septic shock, myocardial infarction/cardiogenic shock (n=1705), and coronary artery bypass graft surgery groups. The pattern of survival for the injury group was somewhat better, exceeding 30% at year-end. Conclusions-Regardless of initial pathology, patients requiring ECMO were critically ill with similar guarded prognoses.Those in the trauma group had somewhat better outcomes. Determining the efficacy and cost-effectiveness of ECMO should be a critical future goal. Continuing medical education (CME) credit is available for this article. Go to http://cme.ahajournals.org to take the quiz.Received August 22, 2015; accepted April 19, 2016. claims database contains extensive clinical data obtained during the roll out of this therapeutic modality and thus allows the study of the outcomes of patients on ECMO. Despite the efficacy of prompt ECMO support as an acute lifesaving strategy in cardiovascular emergencies, the overall mortality associated with cardiogenic shock...

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“…Reports using the first strategy, as the current report, often included patients requiring E-CPR and had an in-hospital mortality ranging from 41 to 67%. Presentations suggesting a profound PCAS on ECMO are always the independent predictors of in-hospital mortality in such reports [7,22,23]. In the other hand, the post-PCI TIMI flow <3 often predicts in-hospital mortality in reports with a conservative attitude of CABG [8,23].…”

Section: Discussionmentioning

confidence: 99%

“…To understand ECMO outcomes in this category better, we searched PubMed for reports that are focused on using ECMO to rescue AMI-induced cardiopulmonary collapse. Five reports [7,8,[21][22][23] published within 5 years were found and summarized in Table 3. According to Table 3, 3 strategies of myocardial revascularization on ECMO were found: (1) early PCI with CABG as a complementary reperfusion method [7,22,23], (2) early PCI without CABG [8], and (3) delayed (2-5 days on ECMO) PCI with CABG as a complementary reperfusion method in patients able to wean off ECMO [21].…”

Section: Discussionmentioning

confidence: 99%