van den Brink F S, Magan A D, Noordzij P G, Zivelonghi C, Agostoni P, Eefting F D, Ten Berg J M, Suttorp M J, Rensing B R, van Kuijk J P, Klein P, Scholten E, van der Heyden J A S
Department of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands.
Department of Intensive Care, St Antonius Hospital, Nieuwegein, The Netherlands.
Neth Heart J. 2018 Feb;26(2):76-84. doi: 10.1007/s12471-017-1068-y.
Primary percutaneous coronary intervention (pPCI) in ST-elevation myocardial infarction (STEMI) can cause great haemodynamic instability. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) can provide haemodynamic support in patients with STEMI but data on outcome and complications are scarce.
An in-hospital registry was conducted enrolling all patients receiving VA-ECMO. Patients were analysed for medical history, mortality, neurological outcome, complications and coronary artery disease.
Between 2011 and 2016, 12 patients underwent pPCI for STEMI and received VA-ECMO for haemodynamic support. The majority of the patients were male (10/12) with a median age of 63 (47-75) years and 4 of the 12 patients had a history of coronary artery disease. A cardiac arrest was witnessed in 11 patients. The left coronary artery was compromised in 8 patients and 4 had right coronary artery disease. All patients were in Killip class IV. Survival to discharge was 67% (8/12), 1‑year survival was 42% (5/12), 2 patients have not yet reached the 1‑year survival point but are still alive and 1 patient died within a year after discharge. All-cause mortality was 42% (5/12) of which mortality on ECMO was 33% (4/12). Patient-related complications occurred in 6 of the 12 patients: 1 patient suffered major neurological impairment, 2 patients suffered haemorrhage at the cannula site, 2 patients had limb ischaemia and 1 patient had a haemorrhage elsewhere. There were no VA-ECMO hardware malfunctions.
VA-ECMO in pPCI for STEMI has a high survival rate and neurological outcome is good, even when the patient is admitted with a cardiac arrest.
ST段抬高型心肌梗死（STEMI）患者进行直接经皮冠状动脉介入治疗（pPCI）可导致严重的血流动力学不稳定。静脉-动脉体外膜肺氧合（VA-ECMO）可为STEMI患者提供血流动力学支持，但关于其结局和并发症的数据较少。
开展一项住院患者登记研究，纳入所有接受VA-ECMO治疗的患者。分析患者的病史、死亡率、神经学结局、并发症和冠状动脉疾病情况。
2011年至2016年期间，12例STEMI患者接受了pPCI并接受VA-ECMO以获得血流动力学支持。大多数患者为男性（10/12），中位年龄为63（47 - 75）岁，12例患者中有4例有冠状动脉疾病史。11例患者出现心脏骤停。8例患者左冠状动脉受累，4例有右冠状动脉疾病。所有患者均为Killip IV级。出院生存率为67%（8/12），1年生存率为42%（5/12），2例患者尚未达到1年生存时间但仍存活，1例患者在出院后1年内死亡。全因死亡率为42%（5/12），其中ECMO期间死亡率为33%（4/12）。12例患者中有6例发生了与患者相关的并发症：1例患者出现严重神经功能损害，2例患者在插管部位出血，2例患者出现肢体缺血，1例患者在其他部位出血。未发生VA-ECMO硬件故障。
STEMI患者进行pPCI时使用VA-ECMO具有较高的生存率，即使患者入院时出现心脏骤停，神经学结局也较好。
