Clinical research of extracorporeal membrane oxygenation support in acute myocardial infarction with cardiogenic shock / 中华急诊医学杂志

ABSTRACT

Objective:To summarize the clinical experience of extracorporeal membrane oxygenation (ECMO) support in acute myocardial infarction (AMI) complicated by cardiogenic shock.Methods:Thirty-seven AMI patients received ECMO from March 2016 to October 2020 in Emergency Department of the First Affiliated Hospital of Nanjing Medical University were retrospectively analyzed. Gensini score was used to evaluate the coronary lesion severity, vasoactive-inotropic score (VIS) was used to assess the usage of vasoactive-inotropic drugs, and cumulative fluid balance (CFB) was used to calculate the fluid balance status, respectively. According to the infarct-related artery, positive/negative fluid balance, and survival/death outcome, the patients were divided into the negative and positive fluid balance groups, and the survival and death groups, respectively. The relationship between Gensini score, 24-hVIS, CFB and patient outcome was analyzed.Results:Thirty AMI-ECMO patients were enrolled, 12 patients survived and 18 died with a mortality rate of 60.0%, and 80.0% of the infarct-related artery were left main and proximal left anterior descending artery. The Gensini score was 77 (52, 120), 24-h VIS 50.0 (31.1, 80.4), daily fluid volume 28.7 (26.6, 34.4) mL/(kg·d), and CBF -1.8 (-9.7, 8.0) mL/kg. The mortality and 24-h VIS of the negative fluid balance group were significantly lower than those of the positive fluid balance group, and the Gensini score, 24-h VIS and CBF of the survival group were significantly lower than those of the death group.Conclusions:LM and pLAD are the most common infarct-related arteries in AMI-ECMO patients, the Gensini score and 24-h VIS have a certain prognostic value, and early negative fluid balance may improve the survival rate.