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.
- 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).