Format

Send to

Choose Destination
Ann Thorac Surg. 2019 Jun 5. pii: S0003-4975(19)30727-1. doi: 10.1016/j.athoracsur.2019.04.049. [Epub ahead of print]

Extracorporeal life support in myocardial infarction-induced cardiogenic shock: Weaning success.

Author information

1
Department of Cardiac Surgery, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, AUSTRIA.
2
Department of Cardiology, Innsbruck Medical University.
3
Department of Medical Statistics, Informatics and Health Economics, Innsbruck Medical University.
4
Department of Anaesthesiology and Intensive Care Medicine, Innsbruck Medical University.
5
Department of Cardiac Surgery, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, AUSTRIA. Electronic address: elfriede.ruttmann@i-med.ac.at.

Abstract

BACKGROUND:

Outcome data of patients with acute myocardial infarction-induced (AMI) cardiogenic shock (CS) receiving extracorporeal life support (ECLS) are sparse.

METHODS:

A consecutive series of 106 patients with AMI-induced CS receiving ECLS was evaluated regarding ECLS weaning success, hospital mortality, and long-term outcome. The IABP-SHOCK II risk score was applied and multivariable Cox regression analysis was performed.

RESULTS:

Mean patient age was 58.2 ± 11.2 years and 78.3% were male gender. In 34 patients (32.1%) ECLS was implemented during ongoing CPR. De novo AMI was present in 58 patients (54.7%), PCI complications causative among 48 patients (45.3%). Multi-vessel coronary artery disease was diagnosed among 73.6% with mean SYNTAX scores of 30.8 ± 4.8. Actuarial 30-day survival was 54.4%, 42.2% at 1 year and 38.0% at 5 years and was significantly higher among patients with low and intermediate IABP-SHOCK II risk scores at ECLS onset (log-rank: p=0.017). ECLS weaning with curative intention after a mean perfusion time of 6.6 ± 5.1 days was feasible in 51 patients (48.1%) and more likely among patients with complete revascularization (p=0.026). Multivariable Cox regression analysis identified complete revascularization (HR: 2.38; 95% CI: 1.1 - 5.1; p=0.028) and absence of relevant mitral regurgitation at ECLS discontinuation (HR: 2.71, 95% CI: 1.2 - 6.0; p=0.014) to be associated with beneficial long-term survival after ECLS discontinuation.

CONCLUSIONS:

Emergency ECLS is a valuable option among patients with AMI-induced CS with low and intermediate IABP SHOCK II risk scores. ECLS weaning is manageable but additional revascularization of all non-culprit lesions is mandatory after ECLS implementation.

KEYWORDS:

acute myocardial infarction; cardiogenic shock; extracorporeal life support; extracorporeal membrane oxygenation

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center