Effect of combining extracorporeal membrane oxygen-ation and intra-aortic balloon pumping in patients with acute myocardial infarction complicated by cardiogenic shock

WANG Hui; XU Cai-yun; TANG Bai-yi; YI Wei

Abstract：Background Acute Myocardial Infarction (AMI) is a critical and commonly encountered condition in the field of cardiovascular medicine. When AMI is complicated by cardiogenic shock (CS), the clinical scenario becomes significantly more complex and perilous, with a marked increase in patient mortality. Currently, traditional therapeutic approaches such as intra-aortic balloon pumping (IABP) have demonstrated efficacy in improving myocardial perfusion and hemodynamics. However, the supportive capacity of IABP is limited in patients with severe heart failure. In recent years, extracorporeal membrane oxygenation (ECMO), as an advanced extracorporeal circulatory support technology, has been increasingly utilized in clinical practice, offering a novel therapeutic option for patients with severe heart failure. This study aimed to investigate the clinical efficacy of combining IABP and ECMO in patients with AMI complicated by CS, evaluating its impact on myocardial injury, hemodynamic stability, and clinical outcomes. Methods This study retrospectively analyzed the clinical data of 52 patients with AMI complicated by CS admitted to our hospital between May 2023 and May 2024. Based on the treatment methods, the patients were divided into an ECMO group (n=26) and a non-ECMO group (n=26). Post-treatment comparisons were made between the two groups regarding myocardial injury markers such as cardiac troponin I, lactate, and creatine kinase-MB, hemodynamic parameters such as mean arterial pressure, cardiac output, and central venous pressure, and the incidence of complications such as acute kidney injury, bleeding, infection. The primary endpoint of this study was the post-treatment mortality rate and the incidence of complications. Secondary endpoints included changes in myocardial injury markers [cardiac troponin I (cTnI), lactic acid (LAC), creatine kinase isoenzymes (CK-MB)] and improvements in hemodynamic parameters [mean arterial pressure (MAP), cardiac output (CO), central venous pressure (CVP)]. The results of multivariate regression analyses were used to explore the incidence of ECMO complications. Results After treatment, the levels of myocardial injury markers such as cTnI, LAC, and CK-MB in ECMO group were significantly lower than non-ECMO group (P<0.05); MAP and CO in ECMO group were significantly higher than non-ECMO group, while CVP was significantly lower (P<0.05); the mortality rate and the incidence of complications in ECMO group were lower than non-ECMO group (P<0.05). Further multivariate regression analysis showed that age, smoking, hyperlipidaemia and diabetes could affect the incidence of ECMO complications (P<0.05). Conclusions The combined use of IABP and ECMO exhibits substantial therapeutic benefits, including the mitigation of myocardial injury, enhancement of hemodynamic stability, and improvement in clinical prognosis among patients with AMI complicated by CS. Clinicians applying ECMO therapy should pay particular attention to older patients or those with concomitant diabetes mellitus or hyperlipidemia, as they might require more intensive monitoring and prophylactic measures to mitigate the occurrence of complications.