Atsushi Sugiura1, Ryuzo Abe2, Takashi Nakayama1, Noriyuki Hattori2, Yoshihide Fujimoto1, Toshiharu Himi3, Koichi Sano4, Shigeto Oda2, Yoshio Kobayashi1. 1. Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan. 2. Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan. 3. Department of Cardiology, Kimitsu Chuo Hospital, Chiba, Japan. 4. Department of Cardiology, Eastern Chiba Medical Center, Chiba, Japan.
Abstract
AIM: While veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been utilized to resuscitate and stabilize hemodynamics in patients of acute myocardial infarction (AMI) complicated by cardiac arrest (CA), it is essential to predict the possibility of weaning from ECMO to determine further strategies, including use of ventricular assist device. We aimed to determine predictors of successful weaning from VA-ECMO in the early phase of ECMO treatment. METHODS: We identified consecutive patients of AMI complicated by CA treated with VA-ECMO and percutaneous coronary intervention (PCI). Clinical data within 48 h after ECMO initiation were assessed and multiple logistic regression analysis was performed to determine independent predictors of weaning outcome. RESULTS: Fifty-five patients were analyzed. While 28 (51%) patients were successfully weaned from VA-ECMO, 27 (49%) failed to wean. Multivariate analysis identified post-PCI thrombolysis in myocardial infarction (TIMI) flow grade (P = 0.046), mean arterial pressure (MAP) at 4 h after ECMO initiation (P = 0.010), and serum lactate at 24 h (P = 0.015) as independent predictors of successful weaning. Left ventricular ejection fraction (LVEF) at 24 and 48 h was significantly greater in the successful weaning group (P = 0.014, P = 0.025, respectively). CONCLUSIONS: Successful weaning from VA-ECMO was predicted by post-PCI TIMI flow grade, MAP at 4 h, and serum lactate at 24 h after VA-ECMO initiation in patients of AMI complicated by CA. Furthermore, in patients who failed to wean from ECMO, LVEF did not recover within 48 h. In such patients, adjunctive use of other circulatory mechanical devices must be considered.
AIM: While veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been utilized to resuscitate and stabilize hemodynamics in patients of acute myocardial infarction (AMI) complicated by cardiac arrest (CA), it is essential to predict the possibility of weaning from ECMO to determine further strategies, including use of ventricular assist device. We aimed to determine predictors of successful weaning from VA-ECMO in the early phase of ECMO treatment. METHODS: We identified consecutive patients of AMI complicated by CA treated with VA-ECMO and percutaneous coronary intervention (PCI). Clinical data within 48 h after ECMO initiation were assessed and multiple logistic regression analysis was performed to determine independent predictors of weaning outcome. RESULTS: Fifty-five patients were analyzed. While 28 (51%) patients were successfully weaned from VA-ECMO, 27 (49%) failed to wean. Multivariate analysis identified post-PCI thrombolysis in myocardial infarction (TIMI) flow grade (P = 0.046), mean arterial pressure (MAP) at 4 h after ECMO initiation (P = 0.010), and serum lactate at 24 h (P = 0.015) as independent predictors of successful weaning. Left ventricular ejection fraction (LVEF) at 24 and 48 h was significantly greater in the successful weaning group (P = 0.014, P = 0.025, respectively). CONCLUSIONS: Successful weaning from VA-ECMO was predicted by post-PCI TIMI flow grade, MAP at 4 h, and serum lactate at 24 h after VA-ECMO initiation in patients of AMI complicated by CA. Furthermore, in patients who failed to wean from ECMO, LVEF did not recover within 48 h. In such patients, adjunctive use of other circulatory mechanical devices must be considered.
Authors: Ravi Vuthoori; Cassandra Heaney; Brian Lima; Alexis Knisel; Ed Miller; Kevin Kennedy; David Majure; Gerin Stevens; Karl Bocchieri; Hugh Cassiere; Harold Fernandez; Simon Maybaum Journal: ESC Heart Fail Date: 2022-04-22
Authors: Jeffrey A Marbach; Pietro Di Santo; Navin K Kapur; Katherine L Thayer; Trevor Simard; Richard G Jung; Simon Parlow; Omar Abdel-Razek; Shannon M Fernando; Marino Labinaz; Michael Froeschl; Rebecca Mathew; Benjamin Hibbert Journal: J Am Heart Assoc Date: 2022-03-09 Impact factor: 6.106