Implementation of extracorporeal membrane oxygenation before primary percutaneous coronary intervention may improve the survival of patients with ST-segment elevation myocardial infarction and refractory cardiogenic shock

Huang, Chi‐Cheng; Hsu, Jung-Cheng; Wu, Yen‐Wen; Ke, Shin‐Rong; Huang, Jih-Hsin; Chiu, Kuan–Ming; Liao, Pen-Chih

doi:10.1016/j.ijcard.2018.07.023

Cited by 45 publications

(29 citation statements)

References 30 publications

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“…A study comparing patients with refractory cardiogenic shock complicating ST-segment elevation AMI implanted with VA-ECMO before (n=12) or after (n=34) percutaneous coronary angiography (PCA) reported an improved 6-month survival (58.3% vs. 14.7%, p=0.006) in patients with early VA-ECMO implantation. However, the proportion of patients achieving door-to-balloon time <90 min was lower (9.1% vs. 32%) (23). In 106 consecutive patients implanted with VA-ECMO around PCA for refractory cardiogenic shock, the implantation of VA-ECMO before or during PCA granted the most favorable 30-day survival compared to implantation after PCA (24).…”

Section: Circulatory Support For High-risk Invasive Proceduresmentioning

confidence: 95%

Venoarterial extracorporeal membrane oxygenation in cardiogenic shock: indications, mode of operation, and current evidence

Chambrun

Bréchot

Combes

2019

Current Opinion in Critical Care

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Purpose of review: Temporary circulatory support (TCS) with venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used as a salvage therapy for patients with refractory cardiogenic shock. This article provides an overview of VA-ECMO principles, indications, management, complications and discusses the results of recent case series and trials. Recent findings: VA-ECMO is utilized as a bridge to "decision" that includes weaning after cardiac function recovery, transplantation, long-term mechanical circulatory support and withdrawal in case of futility. VA-ECMO is considered the first-line TCS since it allows rapid improvement in oxygenation, is less expensive, and is also suitable for patients with biventricular failure. Combining Impella or intra-aortic balloon pump support with VA-ECMO might decrease left ventricular pressure and improve outcomes. Massive pulmonary embolism, sepsis-associated cardiomyopathy, refractory cardiac arrest are among emerging indications for TCS. Summary: TCS have become the cornerstone of the management of patients with cardiogenic shock, although the evidence supporting their efficacy is limited. VA-ECMO is considered the first-line option, with a growing number of accepted and emerging indications. Randomized clinical trials are now needed to determine the place VA-ECMO in cardiogenic shock treatment strategies.

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Section: Circulatory Support For High-risk Invasive Proceduresmentioning

confidence: 95%

Venoarterial extracorporeal membrane oxygenation in cardiogenic shock: indications, mode of operation, and current evidence

Chambrun

Bréchot

Combes

2019

Current Opinion in Critical Care

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“…In a recent retrospective study, general use of Impella was not associated with improved survival compared with the IABP 6. However, the percutaneous assist devices pooled in the analyses have differing support capabilities and mode of action, and there is increasing evidence of a possible timing issue favouring early application of MCS 7–12. Therefore, we sought to investigate the use of MCS in AMICS and assessed the temporal trends in the choice of the device and the patient characteristics of those receiving MCS between 2010 and 2017.…”

Section: Introductionmentioning

confidence: 99%

Contemporary trends in use of mechanical circulatory support in patients with acute MI and cardiogenic shock

et al. 2020

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ObjectivesTo describe the contemporary trends in the use of mechanical circulatory support (MCS) in patients with acute myocardial infarction and cardiogenic shock (AMICS). To evaluate survival benefit with early application of intra-aortic balloon pump (IABP) or Impella CP.MethodsA cohort study of all consecutive patients with AMICS undergoing percutaneous coronary intervention (PCI) <24 hours of symptom onset (early PCI) in southeastern Denmark from 2010 to 2017. A matched case–control study comparing 30-day mortality between patients receiving early-IABP or early-Impella CP and their respective control group. Controls were matched on age, left ventricular ejection fraction, arterial lactate, estimated glomerular filtration rate and cardiac arrest before PCI. Early-IABP/Impella CP was defined as applied before PCI if shock developed pre-PCI, or immediately after PCI if shock developed during PCI.Results903 patients with AMICS undergoing early PCI were identified. Use of MCS decreased from 50% in 2010 to 25% in 2017, p for trend of <0.001. The IABP was abandoned in 2012 and replaced mostly by Impella CP. Patients receiving MCS in 2013–2017 had more compromised haemodynamics compared with patients receiving MCS in 2010–2012. 40 patients received early IABP, and 40 patients received early Impella CP. Only the group receiving early Impella CP was associated with lower 30-day mortality compared with their matched control group (30-day mortality 40% vs 77.5%, plog-rank of<0.001).ConclusionUse of MCS decreased by 50% from 2010 to 2017. Patients receiving MCS had more compromised haemodynamics in recent years. Early application of Impella CP was associated with reduced 30-day mortality compared with a matched control group.

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“…Similarly, the reduced incidence of MACE and cerebral events as well as the more favorable short-term outcome in HR-PCI patients supported by VA-ECMO has been reported by Tommasello et al [13]. Huang et al successfully demonstrated that prophylactic ECMO implantation in STEMI patients with refractory CS significantly improved both short-and long-term outcomes [17].…”

Section: General Aspectsmentioning

confidence: 56%

Cardiac intensive care management of high-risk percutaneous coronary intervention using the venoarterial ECMO support

Zuin

Rigatelli²

2019

Heart Fail Rev

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The emerging concept of high-risk percutaneous coronary intervention (HR-PCI) has required the adoption of a multidisciplinary team approach. Venoarterial ECMO (VA-ECMO) has been introduced as a temporary mechanical circulatory support (MCS) for HR-PCI patients in order to provide an adequate systemic perfusion during the procedure. Both patient's complexity and technological evolutions have catalyzed the development of critical care cardiology; however, ECMO therapy faces several challenges. Indeed, the management of patients on ECMO remains complex; moreover, the lack of specific recommendation for HR-PCI patients further complicates the management of these patients. In this narrative review, we give a reappraisal for the management of HR-PCI patients supported with VA-ECMO according to the available data published in current literature.

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Implementation of extracorporeal membrane oxygenation before primary percutaneous coronary intervention may improve the survival of patients with ST-segment elevation myocardial infarction and refractory cardiogenic shock

Cited by 45 publications

References 30 publications

Venoarterial extracorporeal membrane oxygenation in cardiogenic shock: indications, mode of operation, and current evidence

Venoarterial extracorporeal membrane oxygenation in cardiogenic shock: indications, mode of operation, and current evidence

Contemporary trends in use of mechanical circulatory support in patients with acute MI and cardiogenic shock

Cardiac intensive care management of high-risk percutaneous coronary intervention using the venoarterial ECMO support

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