Incidence and predictors of acute limb ischemia in acute myocardial infarction complicated by cardiogenic shock

Romero, Carlos Manuel; Shafi, Irfan; Patil, Aadhar; Secemsky, Eric A.; Weinburg, Ido; Kolluri, Raghu; Zhao, Huaqing; Lakther, Vladimir; Bashir, Riyaz

doi:10.1016/j.jvs.2022.11.044

Cited by 4 publications

(1 citation statement)

References 22 publications

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“…Considering the possibility of hemodynamic instability or cardiac arrest during high-risk PCI, the use of ECMO can provide robust circulatory support and significantly improve patient prognosis (6,7,15,16). However, VA-ECMO may also increase the risk of complications, such as elevated cardiac afterload, bleeding, lower limb arterial ischemia, hemolysis, AKI, and a higher susceptibility to infections (7,(17)(18)(19)(20)(21). As there is currently limited clinical data on using VA-ECMO as mechanical circulatory support MCS during highrisk PCI, guidelines do not include specific recommendations.…”

Section: Discussionmentioning

confidence: 99%

Standby extracorporeal membrane oxygenation: a better strategy for high-risk percutaneous coronary intervention

Liu,

Li,

et al. 2024

Front. Med.

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BackgroundThe incidence of cardiac arrest (CA) during percutaneous coronary intervention (PCI) is relatively rare. However, when it does occur, the mortality rate is extremely high. Extracorporeal cardiopulmonary resuscitation (ECPR) has shown promising survival rates for in-hospital cardiac arrests (IHCA), with low-flow time being an independent prognostic factor for CA. However, there is no definitive answer on how to reduce low-flow time.MethodsThis retrospective study, conducted at a single center, included 39 patients who underwent ECPR during PCI between January 2016 and December 2022. The patients were divided into two cohorts based on whether standby extracorporeal membrane oxygenation (ECMO) was utilized during PCI: standby ECPR (SBE) (n = 13) and extemporaneous ECPR (EE) (n = 26). We compared the 30-day mortality rates between these two cohorts and investigated factors associated with survival.ResultsCompared to the EE cohort, the SBE cohort showed significantly lower low-flow time (P < 0.01), ECMO operation time (P < 0.01), and a lower incidence of acute kidney injury (AKI) (P = 0.017), as well as peak lactate (P < 0.01). Stand-by ECMO was associated with improved 30-day survival (p = 0.036), while prolonged low-flow time (p = 0.004) and a higher SYNTAX II score (p = 0.062) predicted death at 30 days.ConclusionsStandby ECMO can provide significant benefits for patients who undergo ECPR for CA during PCI. It is a viable option for high-risk PCI cases and may enhance the overall prognosis. The low-flow time remains a critical determinant of survival.

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