Extracorporeal membrane oxygenation-assisted primary percutaneous coronary intervention may improve survival of patients with acute myocardial infarction complicated by profound cardiogenic shock

Journal of Critical Care, 05/21/2012

Tsao NW et al. – Extracorporeal membrane oxygenation–assisted percutaneous coronary intervention (PCI) for patients with acute myocardial infarction (AMI) that is complicated by profound cardiogenic shock (CS) may improve the 30–day and 1–year survival rates.

Methods

  • The authors collected patients from January 2004 through December 2006 (stage 1); 25 patients who presented with AMI and received primary PCI and had profound CS were enrolled in the study.
  • Intra-aortic balloon counter-pulsation (IABP) was the only modality for extracorporeal support in the hospital.
  • From January 2007 through December 2009 (stage 2), 33 patients who presented with AMI and received primary PCI and had profound CS were enrolled; for this stage; both intra-aortic balloon counter-pulsation and ECMO support were available in the facility.

Results

  • A Kaplan-Meier survival analysis displayed significantly improved survival for patients in stage 2 (P=.001; 1-year survival in stage 1 vs 2; 24% vs 63.64%).
  • Patients presenting with either STEMI (ST segment elevation myocardial infarction) or NSTEMI (Non-ST segment elevation myocardial infarction) benefited from ECMO-assisted PCI (P<.05).
  • In stage 1, patients with refractory ventricular tachycardia/ventricular fibrillation had a very low survival rate; however, in stage 2, the survival rate of patients with and without refractory ventricular tachycardia/ventricular fibrillation was similar (P=.316).

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