Percutaneous Extracorporeal Life Support for Treatment of Fatal Mechanical Complications Associated with Acute Myocardial Infarction

Abstract

Mechanical complications of acute myocardial infarction (AMI), such as free wall rupture, ventricular septal perforation (VSP), and mitral regurgitation due to papillary muscle rupture, are associated with high mortality rates. These complications result in extreme deterioration and increased risk of death in patients who do not receive timely resuscitation and surgical treatment. We studied the effectiveness of percutaneous extracorporeal life support (ECLS) for fatal mechanical AMI complications. Nine patients (7 men and 2 women, mean age 69 +/- 6 years) who suffered circulatory collapse refractory to conventional resuscitation were treated with ECLS. Circulatory collapse was caused by free wall rupture in 4 patients, VSP in 4, and mitral regurgitation due to papillary muscle rupture in 1. All patients were successfully resuscitated by ECLS and underwent surgical repair with conventional cardiopulmonary bypass. Eight patients required ECLS after surgery. Four of the 9 patients (2 with free wall rupture, 1 with VSP, and 1 with papillary muscle rupture) were successfully weaned from ECLS and were discharged. Three of the 4 survivors had no major complications, but the remaining survivor suffered neurological deficit. Four patients died while on devices. The duration of ECLS was from 13 to 167 h (mean 76 +/- 57 h) with a maximum bypass flow of 2.0 to 3.9 L/min (mean 2.9 +/- 0.6 L/min). There were no device-related complications during the support period. Total weaning rate was 56% (5/9), and survival was 44% (4/9). We conclude that ECLS can provide appropriate circulatory support during resuscitation and subsequent postoperative circulatory support for cardiovascular collapse associated with AMI complications.

An observational study of extracorporeal CPR for in-hospital cardiac arrest secondary to myocardial infarction

“…Most of the patients in these studies were of heterogeneous aetiologies of cardiopulmonary diseases 9 11 13–15. Some of them evaluated the role of ECPR in patients with cardiogenic shock,16–18 but only few of them suggested that ECPR may promote survival for patients with AMI 5 19 20. Our study confirmed that cardiac arrest patients from AMI can benefit from ECPR.…”

Veno-arterial-ECMO in the intensive care unit: From technical aspects to clinical practice

“…Even if European and American guidelines recommend VA-ECMO use in case of ACS leading to heart failure refractory to medical treatment, with IIa and IIb proof levels respectively [61,62], to our knowledge, no randomized study has ever reported any benefit of VA-ECMO as compared to medical treatment alone. These guidelines are only supported by results from observational series [3,[63][64][65]. Indeed, a historical case-control study published in 2010 reported a benefit of VA-ECMO on 30-day survival (OR = 0.22 ; 95%CI [0.06-0.80] ) in 71 patients with profound cardiogenic shock and acute coronary syndrome [65].…”

Percutaneous occlusion of post-myocardial infarction ventricular septum rupture

“…The decision as to whether deferring is feasible or not should be based on the haemodynamic stability of the patient. Patients will typically be treated with supportive medication, an intra-aortic balloon pump (IABP) and/or mechanical circulatory support (MSC) [11, 15]. …”