Unoki Takashi, Nakayama Tomoko, Saku Keita, Matsushita Hiroki, Inamori Taiji, Matsuura Junya, Toyofuku Takaaki, Sato Tomohide, Konami Yutaka, Suzuyama Hiroto, Inoue Masayuki, Horio Eiji, Kodama Kazuhisa, Taguchi Eiji, Nishikawa Takuya, Sawamura Tadashi, Nakao Koichi, Sakamoto Tomohiro, Okumura Ken, Koyama Junjiro
Intensive Care Unit, Saiseikai Kumamoto Hospital, Kumamoto, Kumamoto, Japan; Department of Circulatory Dynamics, National Cerebral and Cardiovascular Center Research, Osaka, Osaka, Japan; Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan.
Intensive Care Unit, Saiseikai Kumamoto Hospital, Kumamoto, Kumamoto, Japan.
J Cardiol. 2025 May;85(5):352-359. doi: 10.1016/j.jjcc.2024.12.003. Epub 2024 Dec 16.
Venoarterial-extracorporeal membrane oxygenation (VA-ECMO) is a vital mechanical circulatory support for treating patients with refractory cardiogenic shock (CS). VA-ECMO can improve end-organ perfusion; however, it increases left ventricular (LV) afterload, resulting in further myocardial damage. ECPELLA, a combination of VA-ECMO and Impella (Abiomed Inc., Danvers, MA, USA) treatments, is an emerging modality to optimize end-organ perfusion and LV unloading. The impact of ECPELLA in refractory CS has not been established. We aimed to investigate the effects of ECPELLA on acute-phase LV damage and outcomes in patients with acute myocardial infarction (AMI) and refractory CS and compare them with those of VA-ECMO with an intra-aortic balloon pump (IABP).
This single-center retrospective observational study included 90 consecutive patients with AMI and refractory CS who received VA-ECMO between January 2012 and December 2022. Of these, 44 and 46 received ECPELLA and VA-ECMO with IABP, respectively. We assessed the serum creatine kinase myocardial band (CK-MB) levels and 1-year mortality.
No significant differences were observed in the baseline characteristics and time from onset to reperfusion between the two groups. Compared with VA-ECMO with IABP, ECPELLA produced lower peak CK-MB levels (265 IU/L vs. 500 IU/L, p = 0.016) and a smaller area under the curve of CK-MB during the first 3 days (274 IU/L × d vs. 534 IU/L × d, p = 0.025). ECPELLA was associated with significantly lower 1-year mortality (64% vs 91%; p = 0.001). Cox proportional hazards analysis revealed that ECPELLA was inversely and independently associated with 1-year mortality (hazard ratio: 0.38, 95% confidence interval: 0.23-0.64; p < 0.001).
Our findings suggest that ECPELLA may offer myocardial protection and be associated with improved 1-year mortality in patients with AMI and refractory CS. Further prospective studies are needed to confirm these observations and better understand the potential benefits of ECPELLA in this population.
静脉-动脉体外膜肺氧合（VA-ECMO）是治疗难治性心源性休克（CS）患者的重要机械循环支持手段。VA-ECMO可改善终末器官灌注；然而，它会增加左心室（LV）后负荷，导致进一步的心肌损伤。ECPELLA是VA-ECMO与Impella（美国马萨诸塞州丹弗斯市的Abiomed公司）联合治疗的一种方式，是一种优化终末器官灌注和左心室卸载的新兴模式。ECPELLA在难治性CS中的影响尚未明确。我们旨在研究ECPELLA对急性心肌梗死（AMI）合并难治性CS患者急性期左心室损伤和预后的影响，并将其与使用主动脉内球囊泵（IABP）的VA-ECMO进行比较。
这项单中心回顾性观察研究纳入了2012年1月至2022年12月期间连续90例接受VA-ECMO治疗的AMI合并难治性CS患者。其中，分别有44例和46例接受了ECPELLA和使用IABP的VA-ECMO治疗。我们评估了血清肌酸激酶心肌型同工酶（CK-MB）水平和1年死亡率。
两组在基线特征和从发病到再灌注的时间方面未观察到显著差异。与使用IABP的VA-ECMO相比，ECPELLA产生的CK-MB峰值水平更低（265 IU/L对500 IU/L，p = 0.016），且在最初3天内CK-MB曲线下面积更小（274 IU/L×d对534 IU/L×d，p = 0.025）。ECPELLA与显著更低的1年死亡率相关（64%对91%；p = 0.001）。Cox比例风险分析显示，ECPELLA与1年死亡率呈负相关且独立相关（风险比：0.38，95%置信区间：0.23 - 0.64；p < 0.001）。
我们的研究结果表明，ECPELLA可能提供心肌保护作用，并与AMI合并难治性CS患者1年死亡率的改善相关。需要进一步的前瞻性研究来证实这些观察结果，并更好地了解ECPELLA在该人群中的潜在益处。
