Predictors of survival following extracorporeal cardiopulmonary resuscitation in patients with acute myocardial infarcti
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RESEARCH ARTICLE
Open Access
Predictors of survival following extracorporeal cardiopulmonary resuscitation in patients with acute myocardial infarction-complicated refractory cardiac arrest in the emergency department: a retrospective study Sang Jin Han1, Hyoung Soo Kim2*, Hyun Hee Choi1, Gyung Soon Hong1, Won Ki Lee3, Sun Hee Lee2, Dong Geun You4 and Jae Jun Lee4
Abstract Background: This study aimed to identify the determinant factors for clinical outcomes and survival rates of patients with cardiac arrest (CA) concurrent with acute myocardial infarction (AMI) who underwent extracorporeal cardiopulmonary resuscitation (ECPR) using extracorporeal membrane oxygenation (ECMO). Methods: We retrospectively evaluated 37 patients admitted to our emergency department between January 2006 and August 2012 for AMI-induced CA treated with ECPR during ongoing continuous chest compressions. Results: Mean patient age was 61.4 ± 11.3 years, and 27 patients (73%) were men. Mean CPR time was 50.8 ± 35.4 min. Door-to-ECMO and door-to-balloon times were 84.4 ± 55.3 and 98.4 ± 56.8 min, respectively. Mean ECMO time was 106.4 ± 84.7 h; nine (24%) patients died within 24 h after ECMO initiation. Twelve (32%) patients were weaned off ECMO, seven (19%) of whom survived >30 days after ECMO removal; all except one had Cerebral Performance Category Grade 1. Of the patients who survived, 5 of them were able to be discharged. In multivariate analysis, statistical significance was only observed in door-to-ECMO time ≤60 min (OR, 6.0; 95% CI, 1,177–852.025; p = 0.033). Conclusion: We conclude that ECMO insertion within 60 min of the arrival of patients with AMI and CA at the ED appears to be a good option for maintaining myocardial and systemic perfusion, thereby increasing the survival rate of these patients. Keywords: Acute myocardial infarction, Cardiac arrest, Extracorporeal circulation, Extracorporeal membrane oxygenation
Background Although prehospital management and early revascularization therapy have considerably contributed to enhance the survival rate of patients with acute myocardial infarction (AMI) concurrent with cardiogenic shock or cardiac arrest (CA), these are the most fatal complications associated with the high mortality rate of AMI [1-4]. Some reports have recently presented cases in * Correspondence: [email protected] 2 Department of Thoracic and Cardiovascular Surgery, Hallym University Medical Center, Hallym University College of Medicine, 77 Sakju-ro, Chuncheon 200-704, Republic of Korea Full list of author information is available at the end of the article
which extracorporeal membrane oxygenation (ECMO) was successfully administered to patients with AMI concurrent with cardiogenic shock, thus enhancing their survival rate [5-9]. Moreover, the use of ECMO is increasing because, in combination with cardiopulmonary resuscitation (CPR), ECMO has superior efficacy compared to that of conventional CPR in the treatment of in-hospital CA cases due to various causes [10]. Since not much is known about the practice of e
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