The major adverse kidney events in acute myocardial infarction with extracorporeal cardiopulmonary resuscitation
10.3760/cma.j.issn.1671-0282.2024.02.014
- VernacularTitle:体外膜肺氧合辅助心肺复苏治疗急性心肌梗死的主要肾脏不良事件
- Author:
Huazhong ZHANG
1
;
Zhongman ZHANG
;
Yong MEI
;
Jinru LYU
;
Deliang HU
;
Feng SUN
;
Wei LI
;
Gang ZHANG
;
Xufeng CHEN
Author Information
1. 南京医科大学第一附属医院急诊中心，南京 210029
- Keywords:
Extracorporeal cardiopulmonary resuscitation;
Acute myocardial infarction;
Major adverse kidney events;
Retrospective analysis
- From:
Chinese Journal of Emergency Medicine
2024;33(2):222-227
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the major adverse kidney events (MAKE) in acute myocardial infarction (AMI) with extracorporeal cardiopulmonary resuscitation (ECPR).Methods:The data of 75 patients with AMI-ECPR in Emergency Medicine Department of the First Affiliated Hospital of Nanjing Medical University from April 2015 to April 2023 were retrospectively analyzed. The patients were grouped by survival/death at 90 days, with/without renal replacement therapy (RRT), and whether to initiate RRT because of acute kidney injury (AKI). age, sex, Charlson comorbidity index, OHCA/IHCA (out-of-hospital/in-hospital cardiac arrest), initial rhythm, Gensini score, ECPR initial blood gas pH and lactate value, no-flow time, time from cardiac arrest to extracorporeal membrane oxygenation (ECMO) initiation (CA-Pump On time), ECMO and RRT treatment time, 90-day survival rate were analyzed. Moreover, the renal function of the survivors was followed up.Results:① Total of 68 AMI-ECPR patients were enrolled, 22 (32.4%) patients survived at 90 days, 54 (79.4%) combined with RRT, and 48 (70.6%) MAKE within 90 days. ②Compared with the death group, the 90-day survival group had a higher proportion of initial shockable heart rhythm, a lower Gensini score, a higher ECPR initial blood gas pH and a lower lactic acid value. ③The severity of coronary artery disease, ECPR initial acidosis and hyperlactacemia in the RRT group was significantly higher than that in the non-RRT group, and all the non-RRT group patients survived. ④ There was no difference between the AKI-RRT group and the non-AKI-RRT group. Of 21 patients with stage 1 AKI initiating RRT, 5 survived, one of them still needs RRT for 90 days, and 7 patients with stage 2 to 3 AKI initiating RRT died.Conclusions:The 90-day MAKE rate in AMI-ECPR patients was as high as 70.6%, and the 90-day renal insufficiency rate in AMI-ECPR survivors with AKI was as high as 20.0%. Active initiation of RRT to avoid AKI or early initiation of RRT may improve the prognosis of AMI-ECPR patients.
