Extracorporeal membrane oxygenation in treating elderly patients with acute myocardial infarction complicated with cardiogenic shock:analysis of prognosis and risk factors / 中华老年医学杂志

ABSTRACT

Objective To investigate the short-term clinical effect of extracorporeal membrane oxygenation(ECMO) for elderly patients with acute myocardial infarction(AMI)complicated with cardiogenic shock and to analyze its risk factors.Methods Clinical data of 55 elderly patients with AMI complicated with cardiogenic shock admitted into Henan Provincial Chest Hospital from January 2011 to July 2018 were retrospectively analyzed.According to the prognosis,patients were divided into the survival group (n =41) and the death group (n =14).Baseline characteristics were compared between the two groups.The short-term prognosis during hospitalization including use of temporary pacemaker,continuous renal replacement therapy and ventilation treatment and complications were compared.Univariate and multivariate logistic regression analysis were used to assess the risk factors for mortality.Results Of the 55 patients,30 patients were male(54.5％),with a mean ±SD age of (67.2±5.3)years.The time from admission to ECMO insertion was(8.6 ± 6.3)h,and the support time was (143.2 ± 61.7) h.There were significant differences in diabetes incidence,hemodynamic indexes,renal function,troponin,B-type natriuretic peptide,lactate levels and the Acute Physiology and Chronic Health Enquiry (APACHE-Ⅱ) score between the two groups (P ＜ 0.05).The dosage of norepinephrine,dobutamine and other vasoactive agents,and the application frequency of continuous renal replacement therapy,invasive ventilation treatment and intra-aortic balloon counterpulsation during hospitalization were increased in the death group compared with the survival group(P＜0.05) Incidence rates of complications including acute kidney injury,infection and multiple organ dysfunction syndrome were higher in death group than in survival group(P＜0.05).Multiple logistic regression analysis showed that advanced age,low left ventricular ejection fraction (LVEF),acute kidney injury,infection and multiple organ dysfunction syndrome were risk factors for the short-term mortality(P＜0.05).Conclusions The prognosis of elderly patients with AMI complicated with cardiogenic shock are poor.ECMO can significantly improve the hemodynamic indexes,but has no effect on the survival time in elderly patients with AMI complicated with cardiogenic shock.The advanced age,low LVEF,acute kidney injury,infection and multiple organ dysfunction syndrome are risk factors for the short-term mortality.