Therapeutic effects of extracorporeal membrane oxygenation combined with emergent percutaneous coronary intervention on cardiac arrest because of acute myocardial infarction

doi:10.3969/j.issn.1002-7386.2018.01.007

Abstract：Objective To investigate the therapeutic effects of extracorporeal membrane oxygenation (ECMO) combined with emergent percutaneous coronary intervention on cardiac arrest because of acute myocardial infarction.Methods The clinical data about 40 patients who were treated by ECMO combined with emergent percutaneous coronary intervention (PCI) in our hospital from January 2015 to October 2016 were retrospectively analyzed.According to whether ECMO was used or not,these patients were divided into removing machine failure group (n =24) and removing machine success group (n =16),moreover,according to whether patients were dead in hospital ot not,the patients were divided into death case group (n =28) and survival case group (n =12).The related factors with removing machine successfully and survival discharge from hospital and their correlation were analyzed by means of Spearman rank correlation test.Results The mean duration of conventional cardiopulmonary resuscitation and extracorporeal membrane oxygenation was (45.2 ± 24.7)min and (103.2 ± 59.5)h,respectively,with success rate of anabiosis being 100％ (40/40).The mean duration of conventional cardiopulmonary resuscitation in removing machine failure group was longer than that in removing machine success group (P ＜ 0.01),however,the length of staying in hospital in removing machine failure group was shorter than that in removing machine success group (P ＜ 0.01),moreover,there was a significant difference in culprit vessel distribution between two groups (P ＜ 0.01).Spearman correlation analysis results showed that the length of staying in cardiac care unit and culprit vessel distribution were closely correlated with removing machine successfully (P ＜ 0.05).The mean duration of conventional cardiopulmonary resuscitation in death case group was longer than that in survival case group (P ＜ 0.01),and the proportion of removing machine in death case group was lower than that in survival case group (P ＜ 0.01),moreover,the length of staying in cardiac care unit was shorter than that in survival case group (P ＜ 0.01).Besides the mean blood pressure after 48-hour ECMO in death case group was significantly lower than that in survival case group (P ＜ 0.01),however,the lactic acid levels in death case group were significantly higher than those in survival case group (P ＜ 0.05).Moreover there was a significant difference in culprit vessel distribution between two groups (P ＜ 0.05).Spearman correlation analysis results showed that the length of staying in cardiac care unit,right coronary artery as culprit vessel,mean arterial pressure at 48 hours after removing ECMO successfully were positively correlated with survival discharge from hospital (P ＜ 0.05).Conclusion The ECMO combined with emergent PCI has satisfactory therapeutic effects on cardiac arrest because of acute myocardial infarction,therefor,which can be used widely in clinical practice.