Acute myocardial infarction complicated by cardiogenic shock: an algorithm based ECMO program can improve clinical outcomes.

Authors

Shinya Unai, MD, Thomas Jefferson UniversityFollow
Daizo Tanaka, MD, Thomas Jefferson UniversityFollow
Nicholas Ruggiero, MD, Thomas Jefferson UniversityFollow
Hitoshi Hirose, MD, Thomas Jefferson UniversityFollow
Nicholas C. Cavarocchi, MD, Thomas Jefferson UniversityFollow

Document Type

Article

Publication Date

3-1-2016

Comments

This article has been peer reviewed. It is the authors' final version prior to publication in Artificial Organs

Volume 40, Issue 3, pages: 261-269, March 2016

The published version is available at DOI: 10.1111/aor.12538. Copyright © Wiley

Abstract

Objective: Extracorporeal membrane oxygenation (ECMO) in our institution resulted in near total mortality prior to the establishment of an algorithm-based program in July 2010. We hypothesized that an algorithm based ECMO program improves the outcome of patients with acute myocardial infarction complicated with cardiogenic shock.

Methods: Between March 2003 and July 2013, 29 patients underwent emergent catheterization for acute myocardial infarction due to left main or proximal left anterior descending artery occlusion complicated with cardiogenic shock (defined as systolic blood pressure < 90mmHg despite multiple inotropes, +- balloon pump, lactic acidosis). Of 29 patients, 15 patients were before July 2010 (Group 1, old program), 14 patients were after July 2010 (Group 2, new program).

Results: There were no significant differences in the baseline characteristics, including age, sex, coronary risk factors and left ventricular ejection fraction, between the two groups. Cardiopulmonary resuscitation prior to ECMO was performed in 2 cases (13%) in Group 1 and 4 cases (29%) in Group 2. ECMO support was performed in 1 case (6.7%) in Group 1 and 6 cases (43%) in Group 2. The 30-day survival of Group 1 vs. Group 2 was 40% vs. 79% (p = 0.03), and one-year survival rate was 20% vs. 56% (p=0.01). The survival rate for patients who underwent ECMO was 0% in Group 1 vs. 83% in Group 2 (p = 0.09). In Group 2, the mean duration on ECMO was 9.8 ± 5.9 days. Of the 6 patients who required ECMO in Group 2, 100% were successfully weaned off ECMO or were bridged to ventricular assist device implantation.

Conclusions: Initiation of an algorithm based ECMO program improved the outcomes in patients with acute myocardial infarction complicated by cardiogenic shock.

Recommended Citation

Unai, MD, Shinya; Tanaka, MD, Daizo; Ruggiero, MD, Nicholas; Hirose, MD, Hitoshi; and Cavarocchi, MD, Nicholas C., "Acute myocardial infarction complicated by cardiogenic shock: an algorithm based ECMO program can improve clinical outcomes." (2016). Department of Surgery Faculty Papers. Paper 131.
https://jdc.jefferson.edu/surgeryfp/131