Radsel Peter, Goslar Tomaz, Bunc Matjaz, Ksela Jus, Gorjup Vojka, Noc Marko
Center for Intensive Internal Medicine, University Medical Center, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Slovenia.
Center for Intensive Internal Medicine, University Medical Center, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Slovenia; Cardiovascular Division and Center for Resuscitation Medicine, University of Minnesota Medical School, Cardiovascular Division, University of Minnesota, Minneapolis, MN, USA.
Resuscitation. 2021 Mar;160:150-157. doi: 10.1016/j.resuscitation.2020.11.028. Epub 2020 Dec 9.
We investigated the spectrum of emergency veno-arterial extracorporeal membrane oxygenation (VA ECMO)-supported interventions including percutaneous coronary intervention (PCI), transcatheter aortic valve implantation (TAVI) and invasive electrophysiology (EP).
Between June 2010 and February 2020, 52 consecutive patients underwent VA ECMO implantation for refractory cardiac arrest (E-CPR) and 78 for profound cardiogenic shock. Percutaneous interventions on VA ECMO included PCI (n = 29), TAVI (n = 4) and EP (n = 1). Surgical interventions were cardiac (n = 36) or non-cardiac (n = 5). During PCI, ECMO flow was maintained at 2.7 ± 1.0 L/min. Of the 40 treated lesions, 48% were located on left anterior descending and 20% on the left main artery. An average 2.0 ± 1.8 DES/patient with diameter 3.2 ± 0.5 mm and stented length 41 ± 35 mm were implanted. PCI success was 83%. TAVI was performed in 4 patients with left ventricular ejection fraction 21 ± 10% and mean aortic valve gradient 41 ± 5 mmHg. After successful valve implantation supported by 1.4 ± 0.1 L/min ECMO flow, mean gradient decreased to 11 ± 5 mmHg without significant aortic regurgitation. In one patient radiofrequency ablation of His bundle followed by permanent pacemaker implantation was performed under ECMO flow of 2.8 L/min. Overall survival to hospital discharge with good neurological recovery was 29% in E-CPR and 44% in profound cardiogenic shock.
Our study showed feasibility and effectiveness of VA ECMO-supported percutaneous interventions in patients with profound hemodynamic collapse.
我们研究了体外膜肺氧合（ECMO）支持下的紧急静脉-动脉干预措施范围，包括经皮冠状动脉介入治疗（PCI）、经导管主动脉瓣植入术（TAVI）和有创电生理检查（EP）。
2010年6月至2020年2月期间，52例连续患者因难治性心脏骤停接受了静脉-动脉ECMO植入（体外心肺复苏[E-CPR]），78例因严重心源性休克接受植入。在静脉-动脉ECMO上进行的经皮干预包括PCI（n = 29）、TAVI（n = 4）和EP（n = 1）。外科干预为心脏手术（n = 36）或非心脏手术（n = 5）。PCI期间，ECMO流量维持在2.7±1.0L/分钟。在40处治疗病变中，48%位于左前降支，20%位于左主干。平均每位患者植入2.0±1.8枚药物洗脱支架（DES），支架直径3.2±0.5mm，支架长度41±35mm。PCI成功率为83%。4例左心室射血分数为21±10%、平均主动脉瓣压差为41±5mmHg的患者接受了TAVI。在1.4±0.1L/分钟的ECMO流量支持下成功植入瓣膜后，平均压差降至11±5mmHg，无明显主动脉瓣反流。1例患者在2.8L/分钟的ECMO流量下进行了希氏束射频消融，随后植入了永久起搏器。E-CPR患者出院时总体生存率且神经功能良好恢复的为29%，严重心源性休克患者为44%。
我们的研究表明，静脉-动脉ECMO支持下的经皮干预措施对于严重血流动力学衰竭患者具有可行性和有效性。
