ABSTRACT
Objective: To explore the safety and efficacy of venous-arterial extracorporeal membrane oxygenation (VA-ECMO) in complex high-risk and indicated patients (CHIP). Methods: This is a single-center retrospective study. Patients who underwent percutaneous coronary intervention (PCI) supported by VA-ECMO in the Second Hospital of Jilin University from June 2018 to January 2020 were enrolled. General clinical data, laboratory examination results, PCI and ECMO process, postoperative complications and prognosis were collected through the electronic medical record system. The endpoint of the study was major adverse cardiovascular events (MACE), defined as complex events including cardiac death, recurrent myocardial infarction, heart failure and malignant arrhythmia. All patients were followed up for 12 months after discharge. Kaplan-Meier method was used for survival analysis. Results: A total of 31 patients, aged (64.6±10.1) years, including 19 males were included. All patients were treated with VA-ECMO before PCI. The ProGlide vascular suture device was embedded by local anesthesia to quickly establish circulation. There were 9 (29.0%) patients with ST-segment elevation myocardial infarction, 10 (32.3%) patients with non-ST-segment elevation myocardial infarction and 12 (38.7%) patients with unstable angina. The number of stents implanted during the operation were 2.8±1.8. The VA-ECMO weaning time was 24.0 (2.0, 88.5) hours. Compared with the results of pre-operation, the patient's postoperative left ventricular ejection fraction was significantly improved (49% (42%, 55%) vs. 43% (35%, 52%), P<0.01], hemoglobin and platelet count levels decreased, the level of creatinine and urea nitrogen was increased (P<0.05). Within 24 hours after operation, hemoglobin decreased>20 g/L was observed in 18 cases (58.1%), puncture site bleeding was found in 2 cases (6.5%), pseudoaneurysm occurred in 1 case (3.2%) and postoperative cerebral infarction occurred in 1 case (3.2%). There were no deaths during the operation, 2 patients died during hospitalization. All discharged patients were followed up for 12 months. The incidence of MACE was 13.8% (4/29). During the follow-up period, 2 patients died. One patient was hospitalized with recurrent myocardial infarction and one patient with heart failure. Survival analysis was performed 12 months after intervention and the cumulative survival rate was 80.0%. Conclusion: The application of VA-ECMO in CHIP interventional therapy is safe, effective and feasible.
ABSTRACT
Objective To evaluate the literature quality of randomized controlled trials (RCTs) on wrist-ankle acupuncture (WAA) for low-back pain in recent ten years; To analyze the existing problems in the clinical research;To provide corresponding improvement suggestions. Methods A computer-based retrieval was performed to search out the reports of RCTs on WAA for low-back pain from CNKI, Wanfang Data, CBM, Chongqing VIP, PubMed, and Cochrane Library was retrieved by computers. The search scope was January 1, 2007 - December 31, 2016. The 25 items in the Consolidated Standards of Reporting Trials (CONSORT) Statement and 6 items of the Standards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA) were consulted for assessing the literature quality of RCTs on WAA for low-back pain. Results 18 articles were included. There were many problems about literature of RCTs on WAA for low-back pain, mainly including that the type of test design was not clear, outcome indicators were incomplete, random method reports were not specific, accepted diagnostic criteria and efficacy criteria were not used, reporting interventions were incomplete. Conclusion Recently, literature quality of RCTs on WAA for low-back pain is low. It is suggested that CONSORT Statement and STRICTA should be taken into consideration in the conducting and reporting of RCTs on WAA for low-back pain, and the report quality of clinical research in this field should be improved.