Results of Extracorporeal Membrane Oxygenation (ECMO) Support before Coronary Reperfusion in Cardiogenic Shock with Acute Myocardial Infarction

Abstract

BackgroundDespite aggressive treatment, the mortality rate of cardiogenic shock with acute myocardial infarction (AMI) is high. We performed extracorporeal membrane oxygenation (ECMO) prior to coronary reperfusion, and evaluated the early clinical results and risk factors.Materials and MethodsFrom May 2006 to November 2009, we reviewed the medical records of 20 patients in cardiogenic shock with AMI (mean age 67.7±11.7 yrs, M : F 14 : 6). After initially performing ECMO using the CAPIOX emergency bypass system (EBS®Terumo, Tokyo, Japan), patients underwent coronary reperfusion (coronary artery bypass grafting, 13; percutaneous coronary intervention, 7).ResultsAll patients were in a cardiogenic shock state, cardiopulmonary resuscitations (CPR) were performed for fourteen patients (mean CPR time 20.8±26.0 min). The mean time from vascular access to the initiation of ECMO was 17.2±9.4 min and mean support time was 3.8±4.0 days. Fourteen patients were able to be weaned from ECMO and ten patients were discharged (mean admission duration 50.1±31.6 days). Patients survived on average 476.6±374.6 days of follow-up. Longer CPR and support time, increased cardiac enzyme, lower ejection fraction, lower albumin, and major complications were the risk factors of mortality (p<0.05).ConclusionThe early application of ECMO prior to coronary reperfusion and control of risk factors allowed for good clinical results in cardiogenic shock with AMI.

Extracorporeal life support in the multidisciplinary management of cardiogenic shock complicating acute myocardial infarction

“…This is in contrast with previous studies that have identified various predictive factors of in-hospital mortality. 6,8,9,11,13,15,16,28 Our subgroup analyses highlighted a survival advantage only in patients aged ≤60 years. Muller et al identified pre-ECLS age >60 years as an independent predictor of intensive care unit death in one of the largest published series of ECLS support for cardiogenic shock in the setting of AMI.…”

“…26 Our results are consistent with previous articles that reported survival rates after ECLS for AMI complicated by cardiogenic shock comprised between 33 and 66%. [5][6][7][8][9][10][11][12][13][14][15][16] Preliminary data identified ECLS support for primary PCI as a significant contributor to the reduction of in-hospital mortality in patients with cardiogenic shock due to AMI. 5 The ideal timing--before or after primary PCI--of ECLS implantation in STEMI patients developing cardiogenic shock is still matter of debate.…”

“…2 ECLS showed encouraging results in critical patients with AMI-related cardiogenic shock and previous articles reported survival rates after ECLS support between 33 and 66%. [5][6][7][8][9][10][11][12][13][14][15][16] We sought to analyze the results and outcomes of ECLS for cardiogenic shock complicating AMI in a single-center experience.…”

Rescue extracorporeal membrane oxygenation for refractory cardiogenic shock

“…In one of the largest observational studies, mean ECMO support was 4.7 days [ 9 ], which was far below the ECMO duration in our patient. Furthermore, longer ECMO support time is one of the risk factors of mortality [ 10 ], which may just reflect the poorer haemodynamic condition of the patient. On the other hand, ECMO does have an inherent myriad of possible complications, which can be machine-related or patient-related.…”

Cardiogenic Shock and the ICU Patient

“…In a study by Chung et al, of 134 CS patients recruited for ECMO, 50% were weaned and 42.5% survived to discharge. 58 In another study by Hei et al, 76% were weaned off ECMO and 63% survived to discharge. 59 In the study by Loforte et al, there were 47 survivors of 73 CS patients and 45% survived to discharge.…”