Clinical evaluation of extracorporeal cardiopulmonary resuscitation in acute myocardial infarction with in-hospital cardiac arrest
10.3760/cma.j.cn114656-20250217-00102
- VernacularTitle:体外心肺复苏治疗急性心肌梗死致院内心脏骤停的临床评价
- 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（江苏省人民医院）急诊与危重症医学科，南京 210029
- Keywords:
Extracorporeal cardiopulmonary resuscitation;
Acute myocardial infarction;
In-hospital cardiac arrest;
Retrospective analysis
- From:
Chinese Journal of Emergency Medicine
2025;34(11):1554-1559
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To summarize the experience and effect of extracorporeal cardiopulmonary resuscitation (ECPR) in acute myocardial infarction (AMI) with in-hospital cardiac arrest (IHCA).Methods:The data of 70 patients with AMI-IHCA-ECPR in extracorporeal life support center of the first affiliated hospital of Nanjing medical university from January 2017 to December 2024 were retrospectively analyzed. The patients were grouped by Survival/death at 90 days, with/without combined intra-aortic balloon pump (IABP). Age, sex, Charlson comorbidity index, 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 treatment time, 90-day survival rate were analyzed.Results:Among the 70 patients with AMI-IHCA-ECPR, 22 (31.4%) patients survived at 90 days, of whom 19 (86.4%) patients had good neurological outcomes. About 50% of AMI-IHCA-ECPR patients had severe multi-vessel coronary artery lesions, and there was no significant difference in survival outcomes among different vascular lesions. In the IABP group, the success rate of ECMO withdrawal was low, the duration of ECMO treatment was long, and the combination of IABP did not reduce the mortality. Compared with the death group, the 90-day survival group had a lower Gensini score, a higher ECPR initial blood gas pH and a lower lactic acid value.Conclusions:AMI-IHCA-ECPR combined with IABP did not show significant survival benefits, and about 50% of patients had severe lesions of multiple coronary arteries. It is difficult to evaluate the prognosis based on a single offender vessel. It is recommended to evaluate the outcome of patients by quantification of the severity of coronary artery lesions by Gensini score.
