[Effect and related factors of extracorporeal cardiopulmonary resuscitation combined with emergent percutaneous coronary intervention on cardiac arrest patients due to acute myocardial infarction].

ABSTRACT

OBJECTIVE: To evaluate the effect of extracorporeal membrane oxygenation (ECMO) combined with primary percutaneous coronary intervention (PPCI) on cardiac arrest in patients with acute myocardial infarction (AMI). METHODS: We retrospectively analyzed the clinical data from twenty cardiac arrest patients due to AMI from January 2010 to January 2015, who received both ECMO and PPCI after failed conventional cardiopulmonary resuscitation (CCPR) procedure in our center. The mean age was (58.8±13.9) years old and seventeen cases were male. The patients were divided into weaned (8 cases) and non-weaned group (12 cases) according to the outcome of ECMO removal, or survivor (6 cases) and non-survivor group (14 cases) according to the in-hospital outcome. The risk factors that affected weaning from ECMO and survival to discharge were analyzed via Spearman rank correlation test. RESULTS: (1) The mean duration of CCPR and ECMO support was (46.7±22.2)min and (102.3±66.6)h, respectively. The rate of return of simultaneous beating was 100%(20/20). (2) CCPR duration was significantly shorter ((35.1±11.8)min vs. (54.4± 24.5) min, P<0.05) and cardiac care unit(CCU) stay time was significantly longer ((20.5±12.3)d vs. (4.3±4.0)d, P<0.05) in weaned group than in non-weaned group. Moreover, a significant difference was identified in culprit vessel distribution between the two groups (P<0.05). Culprit vessel distribution (left anterior descending artery r=-0.612, P<0.01; right coronary artery r=0.612, P<0.01) and length of cardiac care unit stay (r=0.784, P<0.01) were associated with weaned patients. (3) CCPR duration was significantly shorter ((29.2±4.9)min vs. (51.0±24.5)min, P<0.01). CCU stay time was significantly longer(16.0(9.5, 37.8)d vs. 3.0(2.0, 11.0) d, P<0.01). Weaning rate (6/6 vs. 2/14, P<0.01) and mean blood pressure ((87.9±19.4)mmHg(1 mmHg=0.133 kPa) vs. (63.7±18.6)mmHg, P<0.05) were significantly higher, while lactic acid level in arterial blood((1.74±0.85)mmol/L vs. (6.41±5.65) mmol/L, P<0.05) 48 hours after ECMO support was significantly lower in survivor group compared with non-survivor group. Culprit vessel of right coronary artery (r=0.491, P<0.05), length of CCU stay (r=0.609, P<0.01), successful weaning rate (r=0.802, P<0.01), and mean blood pressure at 48 hours after ECMO establishment (r=0.558, P<0.05) were positively associated with survival. CONCLUSION: ECMO combined with PPCI is an effective therapeutic option to rescue AMI patients complicating with cardiac arrest.