Effect of Extra-corporeal Membrane Cxygenation Combined With Percutaneous Coronary Intervention on Cardiac Arrest Patients due to Acute Myocardial Infarction / 中国循环杂志

ABSTRACT

Objectives:To investigate the clinical efficacy and influencing factors on clinical outcome of extracorporeal membrane oxygenation (ECMO) combined with percutaneous coronary intervention (PCI) on cardiac arrest patients due to acute myocardial infarction (AMI). Methods:The clinical data of 37 cardiac arrest patients post AMI who underwent ECMO combined with emergency PCI therapy strategies from January 2015 to January 2017 were retrospectively analyzed. The clinical data of the surviving group (17 cases) and the death group (20 cases) were compared and the outcome determinants were investigated. Results:37 patients were successfully treated with emergency PCI with the help of ECMO device, and the successful operation rate was 100%. The survival rate was 45.9% (17/37). There was no significant difference in gender, age and past history between the two groups (P＞0.05). The proportion of right coronary artery lesion was the highest (47.06%) in the surviving group, and the percent of the left anterior descending coronary artery lesion was the highest (60.00%) in the death group. Most patients (70.0%) in the death group had three vessel lesions and around half the patients (52.9%) in the surviving group had two-vessel lesions. The time of traditional cardiopulmonary resuscitation ([31.4±5.2] min vs [54.6±25.7] min),the time from cardiac arrest to ECMO ([47.5±19.5] h vs [93.6±60.5] h) were significantly shorter, while CCU time (16.0[8.7, 32.6] d vs 4.0[2.0, 12.0] d) was significantly longer in the surviving group compared to the death group (all P＜0.05). The mean arterial pressure at 24 h and 48 h after ECMO was significantly higher in the surviving group (89.6±21.9,87.9±19.4) than in the death group (71.8±19.3, 63.7±18.6) (both P＜0.05). Unconditional logistic regression analysis showed that left anterior descending artery lesion (OR=0.723, 95%CI:0.516~0.947), higher lesion vessel number (OR=1.638,95%CI:1.107~1.729), longer cardiopulmonary resuscitation time (OR=0.712, 95%CI:0.436~0.973), prolonged cardiac arrest to ECMO placement time (OR=0.698, 95%CI:0.411~0.859) were risk factors of death, and the higher MBP at 48 h after ECMO (OR=0.672,95%CI:0.326~0.693) was the protective factor of death (all P＜0.05) in this patient cohort. Conclusions:ECMO combined with emergency PCI is safe and can improve the success rate of rescue in patients with cardiac arrest after acute myocardial infarction.