Complications related to veno-arterial extracorporeal membrane oxygenation in patients with acute myocardial infarction: VA-ECMO complications in AMI.

Abstract

BACKGROUND:

Among various mechanical support devices, veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is the last resort for acute myocardial infarction (AMI) patients complicated with refractory cardiogenic shock or cardiac arrest. The purpose of this study was to investigate the V-A ECMO-related complications in AMI patients who underwent percutaneous coronary intervention (PCI), and to find the association between complications and in-hospital death in that population.

METHODS:

We retrospectively included 101 AMI patients who received V-A ECMO and underwent PCI to the culprit lesion, and divided them into the survivor group (n=43) and the in-hospital death group (n=58). We compared the clinical characteristics and outcomes including complications between the 2 groups, and performed multivariate logistic regression analysis to find factors associated with in-hospital death and major bleeding.

RESULTS:

The incidence of major bleeding including V-A ECMO site bleeding and intracranial hemorrhage was higher in the in-hospital death group (34.5%) than in the survivor group (7%) (p=0.001). Multivariate logistic regression analysis revealed that final thrombolysis in myocardial infarction (TIMI) flow grade ≤2 (OR 4.453, 95% CI1.427-13.894, p=0.010) and major bleeding (OR 4.986, 95% CI1.277-19.466, p=0.021) were significantly associated with in-hospital death. Out-of-hospital cardiac arrest (OHCA) was significantly associated with major bleeding (OR 3.881, 95% CI 1.358-11.089, p=0.011).

CONCLUSIONS:

In AMI patients who received V-A ECMO and underwent PCI, final TIMI flow grade ≤2 and major bleeding were associated with in-hospital death. OHCA was closely associated with major bleeding.

• Authors: Tsukasa Murakami, Kenichi Sakakura, Hiroyuki Jinnouchi, Yousuke Taniguchi, Takunori Tsukui, Yusuke Watanabe, Kei Yamamoto, Masaru Seguchi, Hiroshi Wada, Hideo Fujita
• Journal: Journal of cardiology (J Cardiol) Vol. 79 Issue 2 Pg. 170-178 (02 2022) ISSN: 1876-4738 [Electronic] Netherlands
• PMID: 34716053 (Publication Type: Journal Article)
• Copyright: Copyright © 2021. Published by Elsevier Ltd.

Topics

• Extracorporeal Membrane Oxygenation (adverse effects)
• Hospital Mortality
• Humans
• Myocardial Infarction (complications, therapy)
• Out-of-Hospital Cardiac Arrest (complications)
• Percutaneous Coronary Intervention (adverse effects)
• Retrospective Studies
• Shock, Cardiogenic (complications, therapy)