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《Chinese Journal of Critical Care Medicine》 2019-04
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Extracorporeal membranous oxygenation support for acute myocardial infarction patients in the periprocedural period of percutaneous coronary intervention

Liu Chang-zhi;Zhou Zhu-jiang;Lu Jian-hai;Zuo Liu-er;Department of Critical Care Medicine,Shunde Hospital,Southern Medical University;  
Objective To observe the clinical effect of extracorporeal membrane oxygenation(ECMO)in acute myocardial infarction patients in the periprocedural period of percutaneous coronary intervention(PCI).Methods Patients with high-risk acute myocardial infarction in the periprocedural period of percutaneous coronary intervention,received ECMO treatment for hemodynamic instability in the Shunde Hospital from July 2016 to July 2018 were analyzed.Comparison of clinical data between death group and survival group were done to analyze the risk factors on prognosis.Results Survival to discharge in this study of 14 patients with acute myocardial infarction was 6/14.Eight patients were in death group,six patients were in survival group.The indication for ECMO contained refractory cardiogenic shock(11 patients),refractory cardiac arrest(2 patients),and intractable malignant arrhythmia(1 patient).ECMO treatment was supported in 12 patients after PCI and in 2 patients before PCI.There was no significant difference in proportion of men,year,score of APACHEⅡ,troponin I,CKMB,BNP,left ventricular ejection fraction between two groups(all P0.05).Compared to survival group,higher lactate in death group was observed(mmol/L:12.2 ±5.2 vs.6.2 ±2.2,t=-2.614,P=0.023).Successful PCI was done in 11 patients including six survivals and seven deaths.There were no significant difference in TIMI after PCI,patients with intra-aortic balloon pump,duration of ECMO support,duration of ICU between two groups(all P0.05).Causes of death were multiple-organ failure in 3 patients,refractory heart failure after weaning ECMO in 2 patients,septic shock in 2 patients,and hypoxic-ischemic encephalopathy in 1 patient.Conclusion ECMO improves hemodynamic stability in high-risk acute myocardial infarction patients during the periprocedural period of percutaneous coronary intervention.Assessing the timing of initiation of ECMO support accurately and decreasing complication of ECMO contribute to improving therapeutic efficacy.Lactate level before ECMO support is beneficial to predict prognosis.
【CateGory Index】: R542.22
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