Park Taek Kyu, Yang Jeong Hoon, Choi Seung-Hyuk, Song Young Bin, Hahn Joo-Yong, Choi Jin-Ho, Sung Kiick, Lee Young Tak, Gwon Hyeon-Cheol
Department of Medicine, Division of Cardiology, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, Republic of Korea.
Department of Medicine, Division of Cardiology, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, Republic of Korea ; Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
BMC Anesthesiol. 2014 Apr 14;14:27. doi: 10.1186/1471-2253-14-27. eCollection 2014.
There is no available data on clinical outcome in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock who are supported by an intra-aortic balloon pump (IABP) in combination with extracorporeal life support (ECLS).
We analysed 96 consecutive patients with AMI and complicating cardiogenic shock who were assisted by an ECLS system between January 2004 and December 2011. The primary outcome was in-hospital mortality. The secondary outcomes were the success rate of weaning from ECLS and the lactate clearance for 48 hours (%).
A combination of IABP and ECLS was used in 41 (42.7%) patients. In-hospital mortality occurred for 51 patients (ECLS with IABP versus ECLS alone; 51.2% vs. 54.5%, p = 0.747). The success rate of weaning from ECLS was similar between the two groups (63.4% vs. 58.2%, p = 0.604). Complications such as ischemia of a lower extremity or bleeding at the ECLS insertion site (p = 0.521 and p = 0.667, respectively) did not increase when ECLS was combined with IABP. Among patients who survived for 24 hours after intervention, lactate clearance was not significantly different between patients who received ECLS alone and those who received ECLS with IABP (p = 0.918).
The combined use of ECLS and IABP did not improve in-hospital survival in patients with AMI complicated by cardiogenic shock.
对于合并心源性休克的急性心肌梗死（AMI）患者，在使用主动脉内球囊反搏（IABP）联合体外生命支持（ECLS）治疗时，尚无关于临床结局的可用数据。
我们分析了2004年1月至2011年12月期间96例连续接受ECLS系统辅助的AMI合并心源性休克患者。主要结局是住院死亡率。次要结局是ECLS撤机成功率和48小时乳酸清除率（%）。
41例（42.7%）患者使用了IABP联合ECLS。51例患者发生住院死亡（IABP联合ECLS与单纯ECLS；51.2%对54.5%，p = 0.747）。两组之间ECLS撤机成功率相似（63.4%对58.2%，p = 0.604）。当ECLS与IABP联合使用时，下肢缺血或ECLS置入部位出血等并发症并未增加（分别为p = 0.521和p = 0.667）。在干预后存活24小时的患者中，单纯接受ECLS治疗的患者与接受IABP联合ECLS治疗的患者之间乳酸清除率无显著差异（p = 0.918）。
对于AMI合并心源性休克患者，联合使用ECLS和IABP并不能改善住院生存率。
