Emergency cardiopulmonary bypass support in patients with severe cardiogenic shock after acute myocardial infarction

Abstract

A total of 16 patients who developed severe cardiogenic shock were resuscitated with a percutaneous cardiopulmonary support system (PCPS). The etiology of shock was acute myocardial infarction (n = 7), or post-infarction left-ventricular (LV) free wall rupture (n = 9). After successful resuscitation with the PCPS, 15 patients underwent therapeutic interventions: closure of an LV rupture (n = 9), coronary artery bypass grafting (n = 4), percutaneous transluminal angioplasty (n = 1), and percutaneous transluminal coronary recanalization (n = 1). Of the 16 patients, 14 were weaned from PCPS or standard cardiopulmonary bypass. Six patients survived longer than 30 days, 3 (19 percent) of whom were discharged from the hospital. The long-term survival rate in the 6 patients who underwent coronary revascularization was 33 percent (2/6). Of the 9 patients with LV free wall rupture, 1 was discharged from the hospital. Even though it cannot be concluded, from this small number of patients, that cardiopulmonary resuscitation using PCPS improves survival, it appears that PCPS is a powerful resuscitative modality for seriously ill patients with acute myocardial infarction or LV rupture.

Cardiogenic Shock

“…In DeWood and colleagues' series (81), IABP support was used successfully as a bridge to coronary artery bypass surgery. The roles of other supportive measures, such as emergency cardiopulmonary bypass surgery (128), remain to be defined.…”

Results of Extracorporeal Membrane Oxygenation (ECMO) Support before Coronary Reperfusion in Cardiogenic Shock with Acute Myocardial Infarction

“…Besides the classical medical treatment, circulatory supportive devices such as the Intra Aortic Balloon Pump (IABP) and Ventricular Assistance Device (VAD) may be helpful [1-5]. Recently ECMO has been adapted to the percutaneous approach and the self-charging system, so that it can support the whole body and coronary circulation fast, and has shown good clinical results in patients experiencing cardiogenic shock due to AMI [6-9].…”

Usefulness of transesophageal echocardiography for identifying the precise location of a left ventricular rupture in a patient with collapsed cardiac chamber

“…Matsukawa et al [4] reported that left ventricle repair without coronary revascularization did not improve left ventricular function. We did not perform additional bypass grafting because of the lack of time for coronary angiography and coronary computed tomography, due to the patient's critical condition.…”