Browse > Article
http://dx.doi.org/10.5090/kjtcs.2011.44.4.273

Results of Extracorporeal Membrane Oxygenation (ECMO) Support before Coronary Reperfusion in Cardiogenic Shock with Acute Myocardial Infarction  

Chung, Eui-Suk (Department of Thoracic and Cardiovascular Surgery, Sanggye Paik Hospital, Inje University)
Lim, Cheong (Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital)
Lee, Hae-Young (Department of Thoracic and Cardiovascular Surgery, Kosin University Gospel Hospital)
Choi, Jin-Ho (Department of Thoracic and Cardiovascular Surgery, Eulji University Hospital)
Lee, Jeong-Sang (Department of Thoracic and Cardiovascular Surgery, Seoul Metropolitan Boramae Hospital, Seoul National University)
Park, Kay-Hyun (Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital)
Publication Information
Journal of Chest Surgery / v.44, no.4, 2011 , pp. 273-278 More about this Journal
Abstract
Despite aggressive treatment, the mortality rate of cardiogenic shock with acute myocardial infarction (AMI) is high. We performed extracorporeal membrane oxygenation (ECMO) prior to coronary reperfusion, and evaluated the early clinical results and risk factors. Materials and Methods: From May 2006 to November 2009, we reviewed the medical records of 20 patients in cardiogenic shock with AMI (mean age $67.7{\pm}11.7$ yrs, M : F 14 : 6). After initially performing ECMO using the CAPIOX emergency bypass system ($EBS^{(R)}$Terumo, Tokyo, Japan), patients underwent coronary reperfusion (coronary artery bypass grafting, 13; percutaneous coronary intervention, 7). Results: All patients were in a cardiogenic shock state, cardiopulmonary resuscitations (CPR) were performed for fourteen patients (mean CPR time $20.8{\pm}26.0$ min). The mean time from vascular access to the initiation of ECMO was $17.2{\pm}9.4$ min and mean support time was $3.8{\pm}4.0$ days. Fourteen patients were able to be weaned from ECMO and ten patients were discharged (mean admission duration $50.1{\pm}31.6$ days). Patients survived on average $476.6{\pm}374.6$ days of follow-up. Longer CPR and support time, increased cardiac enzyme, lower ejection fraction, lower albumin, and major complications were the risk factors of mortality (p<0.05). Conclusion: The early application of ECMO prior to coronary reperfusion and control of risk factors allowed for good clinical results in cardiogenic shock with AMI.
Keywords
Extracorporeal membrane oxygenation (ECMO); Coronary reperfusion; Acute myocardial infarction; Cardiogenic shock;
Citations & Related Records
Times Cited By KSCI : 1  (Citation Analysis)
연도 인용수 순위
1 Sung K, Lee YT, Park PW, et al. Improved survival after cardiac arrest using emergent autopriming percutaneous cardiopulmonary support. Ann Thorac Surg 2006;82:651-6.   DOI   ScienceOn
2 Sarkar K, Kini AS. Percutaneous left ventricular support devices. Cardiol Clin 2010;28:169-84.   DOI   ScienceOn
3 Matsuwaka R, Sakakibara T, Shintani H, et al. Emergency cardiopulmonary bypass support in patients with severe cardiogenic shock after acute myocardial infarction. Heart Vessels 1996;11:27-9.   DOI   ScienceOn
4 Suarez de Lezo J, Pan M, Medina A, et al. Percutaneous cardiopulmonary support in critical patients needing coronary interventions with stents. Catheter Cardiovasc Interv 2002;57:467-75.   DOI   ScienceOn
5 Rhee I, Kwon SU, Sung K, et al. Experiences with emergency percutaneous cardiopulmonary support in in-hospital cardiac arrest or cardiogenic shock due to the ischemic heart disease. Korean J Thorac Cardiovasc Surg 2006;39: 201-7.
6 Bhayana JN, Scott SM, Sethi GK, Takaro T. Effects of intraaortic balloon pumping on organ perfusion in cardiogenic shock. J Surg Res 1979;26:108-13.   DOI   ScienceOn
7 Zhang R, Kofidis T, Kamiya H, et al. Creatine kinase isoenzyme MB relative index as predictor of mortality on extracorporeal membrane oxygenation support for postcardiotomy cardiogenic shock in adult patients. Eur J Cardiothorac Surg 2006;30:617-20.   DOI   ScienceOn
8 Mehta SM, Aufiero TX, Pae WE Jr, Miller CA, Pierce WS. Mechanical ventricular assistance: an economical and effective means of treating end-stage heart disease. Ann Thorac Surg 1995;60:284-90.   DOI   ScienceOn
9 Hill JG, Bruhn PS, Cohen SE, et al. Emergent applications of cardiopulmonary support: a multiinstitutional experience. Ann Thorac Surg 1992;54:699-704.   DOI   ScienceOn
10 Reichman RT, Joyo CI, Dembitsky WP, et al. Improved patient survival after cardiac arrest using a cardiopulmonary support system. Ann Thorac Surg 1990;49:101-4.   DOI   ScienceOn
11 Hsu PS, Chen JL, Hong GJ, et al. Extracorporeal membrane oxygenation for refractory cardiogenic shock after cardiac surgery: predictors of early mortality and outcome from 51 adult patients. Eur J Cardiothorac Surg 2010;37:328-33.
12 Antman EM, Anbe DT, Armstrong PW, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction--executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction). Circulation 2004;110: 588-636.   DOI   ScienceOn
13 Rastan AJ, Dege A, Mohr M, et al. Early and late outcomes of 517 consecutive adult patients treated with extracorporeal membrane oxygenation for refractory postcardiotomy cardiogenic shock. J Thorac Cardiovasc Surg 2010;139:302-11, 311.e1.   DOI   ScienceOn
14 Bakhtiary F, Keller H, Dogan S, et al. Venoarterial extracorporeal membrane oxygenation for treatment of cardiogenic shock: clinical experiences in 45 adult patients. J Thorac Cardiovasc Surg 2008;135:382-8.   DOI   ScienceOn
15 Song SW, Yang HS, Lee S, Youn YN, Yoo KJ. Earlier application of percutaneous cardiopulmonary support rescues patients from severe cardiopulmonary failure using the APACHE III scoring system. J Korean Med Sci 2009;24: 1064-70.   DOI   ScienceOn
16 Ryu KM, Kim SH, Seo PW, et al. Initial experience of the emergency bypass system (EBS(R)) for the patients with cardiogenic shock due to an acute myocardial infarction. Korean J Thorac Cardiovasc Surg 2008;41:329-34.
17 Burkle CM, Nuttall GA, Rihal CS. Cardiopulmonary bypass support for percutaneous coronary interventions: what the anesthesiologist needs to know. J Cardiothorac Vasc Anesth 2005;19:501-4.   DOI   ScienceOn
18 Vainer J, van Ommen V, Maessen J, Geskes G, Lamerichs L, Waltenberger J. Elective high-risk percutaneous coronary interventions supported by extracorporeal life support. Am J Cardiol 2007;99:771-3.   DOI   ScienceOn
19 Chen YS, Lin JW, Yu HY, et al. Cardiopulmonary resuscitation with assisted extracorporeal life-support versus conventional cardiopulmonary resuscitation in adults with in-hospital cardiac arrest: an observational study and propensity analysis. Lancet 2008;372:554-61.   DOI   ScienceOn
20 Prodhan P, Fiser RT, Dyamenahalli U, et al. Outcomes after extracorporeal cardiopulmonary resuscitation (ECPR) following refractory pediatric cardiac arrest in the intensive care unit. Resuscitation 2009;80:1124-9.   DOI   ScienceOn