Zhao L, Zhang C P, Wang H R, Li Z B, Liu B
Department of Cardiology, Second Hospital of Jilin University, Changchun 130041, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2021 Aug 24;49(8):757-763. doi: 10.3760/cma.j.cn112148-20210324-00270.
To explore the safety and efficacy of venous-arterial extracorporeal membrane oxygenation (VA-ECMO) in complex high-risk and indicated patients (CHIP). This is a single-center retrospective study. Patients who underwent percutaneous coronary intervention (PCI) supported by VA-ECMO in the Second Hospital of Jilin University from June 2018 to January 2020 were enrolled. General clinical data, laboratory examination results, PCI and ECMO process, postoperative complications and prognosis were collected through the electronic medical record system. The endpoint of the study was major adverse cardiovascular events (MACE), defined as complex events including cardiac death, recurrent myocardial infarction, heart failure and malignant arrhythmia. All patients were followed up for 12 months after discharge. Kaplan-Meier method was used for survival analysis. A total of 31 patients, aged (64.6±10.1) years, including 19 males were included. All patients were treated with VA-ECMO before PCI. The ProGlide vascular suture device was embedded by local anesthesia to quickly establish circulation. There were 9 (29.0%) patients with ST-segment elevation myocardial infarction, 10 (32.3%) patients with non-ST-segment elevation myocardial infarction and 12 (38.7%) patients with unstable angina. The number of stents implanted during the operation were 2.8±1.8. The VA-ECMO weaning time was 24.0 (2.0, 88.5) hours. Compared with the results of pre-operation, the patient's postoperative left ventricular ejection fraction was significantly improved (49% (42%, 55%) vs. 43% (35%, 52%), <0.01], hemoglobin and platelet count levels decreased, the level of creatinine and urea nitrogen was increased (<0.05). Within 24 hours after operation, hemoglobin decreased>20 g/L was observed in 18 cases (58.1%), puncture site bleeding was found in 2 cases (6.5%), pseudoaneurysm occurred in 1 case (3.2%) and postoperative cerebral infarction occurred in 1 case (3.2%). There were no deaths during the operation, 2 patients died during hospitalization. All discharged patients were followed up for 12 months. The incidence of MACE was 13.8% (4/29). During the follow-up period, 2 patients died. One patient was hospitalized with recurrent myocardial infarction and one patient with heart failure. Survival analysis was performed 12 months after intervention and the cumulative survival rate was 80.0%. The application of VA-ECMO in CHIP interventional therapy is safe, effective and feasible.
探讨静脉-动脉体外膜肺氧合（VA-ECMO）在复杂高危及适应证患者（CHIP）中的安全性和有效性。这是一项单中心回顾性研究。纳入2018年6月至2020年1月在吉林大学第二医院接受VA-ECMO支持下经皮冠状动脉介入治疗（PCI）的患者。通过电子病历系统收集一般临床资料、实验室检查结果、PCI及ECMO过程、术后并发症及预后情况。研究终点为主要不良心血管事件（MACE），定义为包括心源性死亡、再发心肌梗死、心力衰竭及恶性心律失常在内的复合事件。所有患者出院后随访12个月。采用Kaplan-Meier法进行生存分析。共纳入31例患者，年龄（64.6±10.1）岁，其中男性19例。所有患者在PCI前均接受VA-ECMO治疗。采用局部麻醉置入ProGlide血管缝合装置以快速建立循环。ST段抬高型心肌梗死患者9例（29.0%），非ST段抬高型心肌梗死患者10例（32.3%），不稳定型心绞痛患者12例（38.7%）。术中植入支架数量为2.8±1.8枚。VA-ECMO撤机时间为24.0（2.0，88.5）小时。与术前结果相比，患者术后左心室射血分数显著改善（49%（42%，55%）对43%（35%，52%），<0.01），血红蛋白和血小板计数水平下降，肌酐和尿素氮水平升高（<0.05）。术后24小时内，18例（58.1%）患者血红蛋白下降>20 g/L，2例（6.5%）患者穿刺部位出血，1例（3.2%）患者发生假性动脉瘤，1例（3.2%）患者发生术后脑梗死。术中无死亡病例，住院期间2例患者死亡。所有出院患者均随访12个月。MACE发生率为13.8%（4/29）。随访期间，2例患者死亡。1例患者因再发心肌梗死住院，1例患者因心力衰竭住院。干预12个月后进行生存分析，累积生存率为80.0%。VA-ECMO在CHIP介入治疗中的应用安全、有效且可行。
