Outcomes of Venoarterial Extracorporeal Membrane Oxygenation Plus Intra‐Aortic Balloon Pumping for Treatment of Acute Myocardial Infarction Complicated by Cardiogenic Shock

Abstract

Background Clinical outcomes of acute myocardial infarction complicated by cardiogenic shock remain poor with high in‐hospital mortality. Veno‐arterial extracorporeal membrane oxygenation (VA‐ECMO) has been widely used for patients with acute myocardial infarction complicated by cardiogenic shock refractory to conservative therapy, which is likely fatal without mechanical circulatory support. However, whether additional intra‐aortic balloon pumping (IABP) use during VA‐ECMO support improves clinical outcomes remains controversial. This study sought to investigate prognostic impact of the combined VA‐ECMO plus IABP treatment compared with VA‐ECMO alone. Methods and Results From the nationwide Japanese administrative case‐mix Diagnostic Procedure Combination (DPC), the JROAD (Japanese Registry of All Cardiac and Vascular Diseases)–DPC, we identified 3815 patients with acute myocardial infarction complicated by cardiogenic shock who underwent primary percutaneous coronary intervention and managed with VA‐ECMO. Of these, 2964 patients (77.7%) were managed with IABP (VA‐ECMO plus IABP), whereas 851 (22.3%) were managed without IABP (VA‐ECMO alone). We compared in‐hospital, 7‐day, and 30‐day mortality between the VA‐ECMO plus IABP versus the VA‐ECMO alone support. Patients managed with VA‐ECMO plus IABP demonstrated significantly lower in‐hospital, 7‐day, and 30‐day mortality than those managed with VA‐ECMO alone (adjusted odds ratios [95% CI] of 0.47 [95% CI, 0.38–0.59], 0.41 [95% CI, 0.33–0.51], and 0.30 [95% CI, 0.25–0.37], respectively). The findings were consistent in the propensity matching and inverse probability of treatment‐weighting models. Conclusions This large‐scale, nationwide study demonstrated that the combination of VA‐ECMO plus IABP support was associated with significantly lower mortality compared with VA‐ECMO support alone in patients presenting with acute myocardial infarction complicated by cardiogenic shock who underwent primary percutaneous coronary intervention.

Adjusted mortality of extracorporeal membrane oxygenation for acute myocardial infarction patients in cardiogenic shock

“…[36] Recent study showed that ECMO, in addition to IABP support with proper management of device-related complications, may lead to improved clinical outcomes of CS in patients with MI (HR 0.30, 95% CI, 0.25-0.37), similar results as shown in the present study. [37] The strength of this study was that long-term mortality included short-term mortality with VA-ECMO + IABP support, which we provided with adjusted incidence rates using various statistical methods. A recent systematic review showed that most studies regarding the clinical outcomes of ECMO support only reported crude incidence and indicated the harmful effects of ECMO during the early stage of MI-CS.…”

“…[36] Recent study showed that ECMO, in addition to IABP support with proper management of device-related complications, may lead to improved clinical outcomes of CS in patients with MI (HR 0.30, 95% CI, 0.25–0.37), similar results as shown in the present study. [37]…”

Meta-analysis of extracorporeal membrane oxygenation in combination with intra-aortic balloon pump vs. extracorporeal membrane oxygenation only in patients with cardiogenic shock due to acute myocardial infarction

“…Two studies reported the decision for additional IABP treatment was made by the physician in charge (28,33), two studies reported that an IABP was routinely implanted in absence of any contra indication (21,30) and one study reported that an additional IABP was implanted in case the arterial pulse wave disappeared after using VA-ECMO support (22). Four studies reported the 30-day/in-hospital mortality (23)(24)(25)28) and eight studies the in-hospital mortality (21,22,26,(30)(31)(32)(33). Overall mortality was 75.1% (n = 3802) and 85.6% (n = 973) in the VA-ECMO and 72% (n = 2829) in the VA-ECMO + IABP group.…”

Influence of Prehospital Emergency Care on Rescue Success Rate and Complication Rate of Senile Patients with Acute Myocardial Infarction

“…Cardiogenic shock (CGS), one of the complications of AMI, is one of the prime reasons for death in AMI patients [ 6 ]. However, at present, the clinical effect of AMI complicated with CGS leaves much to be desired, urgently demanding effective measures that can be taken to lower the incidence of complications to extend patient survival [ 7 ]. This study aims at finding a more suitable nursing method for senile AMI patients from the perspective of nursing care.…”