Asrress Kaleab N, Marciniak Maciej, Briceno Natalia, Perera Divaka
King's College London British Heart Foundation Centre of Excellence, The Rayne Institute, St. Thomas' Hospital, London, England; Department of Cardiology, Royal North Shore Hospital, Sydney, NSW, Australia; The Kolling Institute, Northern Clinical School, University of Sydney, Australia.
King's College London British Heart Foundation Centre of Excellence, The Rayne Institute, St. Thomas' Hospital, London, England.
Heart Lung Circ. 2017 Aug;26(8):e37-e40. doi: 10.1016/j.hlc.2017.01.012. Epub 2017 Feb 28.
Cardiogenic shock in the context of acute ST-elevation myocardial infarction (STEMI) remains a challenge to manage and results in significant mortality and morbidity, cardiac arrest in this setting even more so. The increase in myocardial oxygen demand and consumption with the use of inotropes is recognised as increasing mortality. Alternatives include the intra-aortic balloon pump (IABP), which has yet to be shown to improve outcomes, and extracorporeal membrane oxygenation (ECMO), which requires super-specialised techniques not widely available. We report a case of Anterior STEMI from a left main stem occlusion suffering with cardiac arrest on reaching the catheter laboratory table necessitating external mechanical compression with an Autopulse™. The patient remained in pulseless electrical activity (PEA) throughout, and was Autopulse dependent despite successful percutaneous coronary intervention (PCI). An Impella was inserted for additional mechanical support and facilitated successful weaning from cardiopulmonary resuscitation (CPR). Despite 105minutes without a spontaneous output, we describe the first documented case of simultaneous use of Impella with mechanical CPR with a successful outcome; demonstrating a potential technique of good mechanical haemodynamic support to aide early revascularisation that may have potential utility in the treatment of cardiogenic shock and arrest.
急性ST段抬高型心肌梗死（STEMI）并发的心源性休克在治疗上仍然是一项挑战，会导致显著的死亡率和发病率，在此情况下发生心脏骤停时更是如此。使用正性肌力药物会增加心肌需氧量和耗氧量，这被认为会增加死亡率。其他替代方法包括主动脉内球囊反搏（IABP），但尚未证明其能改善预后，还有体外膜肺氧合（ECMO），这需要超专业技术且未广泛应用。我们报告了一例因左主干闭塞导致的前壁STEMI病例，患者在到达导管实验室手术台时发生心脏骤停，需要使用Autopulse™进行外部机械按压。患者始终处于无脉电活动（PEA）状态，尽管成功进行了经皮冠状动脉介入治疗（PCI），仍依赖Autopulse。插入了Impella以提供额外的机械支持，并促进了从心肺复苏（CPR）中成功撤机。尽管有105分钟没有自主输出，我们描述了首例记录在案的同时使用Impella和机械CPR并取得成功的病例；证明了一种潜在的技术，即良好的机械血流动力学支持有助于早期血管重建，这可能对心源性休克和心脏骤停的治疗具有潜在应用价值。
