Korean Circ J.  2018 Aug;48(8):705-715. 10.4070/kcj.2018.0121.

Relationship between Clinical Outcomes and Cardiopulmonary Resuscitation Time in Patients with Acute Myocardial Infarction Treated by Extracorporeal Membrane Oxygenation-Assisted Primary Percutaneous Coronary Intervention

Affiliations
  • 1Division of Cardiovascular Medicine, Department of Internal Medicine, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea. neosoo70@dankook.ac.kr
  • 2Division of Cardiology, Department of Internal Medicine, Good Morning Hospital, Pyeongtaek, Korea.

Abstract

BACKGROUND AND OBJECTIVES
Extracorporeal membrane oxygenation (ECMO) support is increasingly used in primary percutaneous coronary intervention (PCI) during cardiopulmonary resuscitation (CPR) to treat acute myocardial infarction (AMI) patients who experienced cardiogenic shock. However, to date, there have been no studies on the relationship between clinical outcomes and CPR time in such patients with AMI treated by ECMO-assisted primary PCI.
METHODS
From July 2008 to March 2016, we analyzed data from 42 AMI with cardiogenic shock patients who underwent CPR and were treated by ECMO-assisted primary PCI. The primary outcome was 30-day in-hospital mortality after primary PCI. The predictors of mortality were determined using a Cox proportional hazards model.
RESULTS
Thirty-day in-hospital mortality was observed for 33 patients (78.6%). The mean CPR time was 37.0±37.3 minutes. The best cut-off CPR time value associated with clinical outcome was calculated to be 12.5 minutes using receiver operating characteristic curve analysis. Multivariate analysis revealed that CPR time of > 12.5 minutes was an independent predictor of 30-day mortality (adjusted hazard ratio, 4.71; 95% confidence interval, 1.30-17.406; p=0.018).
CONCLUSIONS
Despite ECMO support, the clinical outcomes of AMI patients with a complication of cardiogenic shock remain poor. Prolonged CPR time is associated with a poor prognosis in patients with AMI treated by ECMO-assisted primary PCI.

Keyword

Myocardial infarction; Cardiogenic shock; Extracorporeal membrane oxygenation; Cardiopulmonary resuscitation

MeSH Terms

Cardiopulmonary Resuscitation*
Extracorporeal Membrane Oxygenation
Hospital Mortality
Humans
Membranes*
Mortality
Multivariate Analysis
Myocardial Infarction*
Percutaneous Coronary Intervention*
Prognosis
Proportional Hazards Models
ROC Curve
Shock, Cardiogenic

Figure

  • Figure 1 Overview of the study scheme. AMI = acute myocardial infarction; CPR = cardiopulmonary resuscitation; DKUH = Dankook University Hospital; ECMO = extracorporeal membrane oxygenation.

  • Figure 2 ROC curve for CPR duration for the prediction of 30-day mortality. CI = confidence interval; CPR = cardiopulmonary resuscitation; ROC = receiver operating characteristic.

  • Figure 3 Thirty-day mortality rates after 0–5, 6–15, 16–30, and >30 minutes of CPR in patients with AMI receiving ECMO-assisted primary PCI. AMI = acute myocardial infarction; CPR = cardiopulmonary resuscitation; ECMO = extracorporeal membrane oxygenation; PCI = percutaneous coronary intervention.

  • Figure 4 Cumulative incidence of mortality in patients who received CPR for >12.5 minutes versus those who received it for ≤12.5 minutes. CPR = cardiopulmonary resuscitation.


Cited by  1 articles

Clinical Significance of Low-flow Time in Patients Treated with Extracorporeal Cardiopulmonary Resuscitation
Jeong Hoon Yang
Korean Circ J. 2018;48(8):716-718.    doi: 10.4070/kcj.2018.0187.


Reference

1. Goldberg RJ, Gore JM, Alpert JS, et al. Cardiogenic shock after acute myocardial infarction. Incidence and mortality from a community-wide perspective, 1975 to 1988. N Engl J Med. 1991; 325:1117–1122.
2. Babaev A, Frederick PD, Pasta DJ, et al. Trends in management and outcomes of patients with acute myocardial infarction complicated by cardiogenic shock. JAMA. 2005; 294:448–454.
Article
3. Goldberg RJ, Spencer FA, Gore JM, Lessard D, Yarzebski J. Thirty-year trends (1975 to 2005) in the magnitude of, management of, and hospital death rates associated with cardiogenic shock in patients with acute myocardial infarction: a population-based perspective. Circulation. 2009; 119:1211–1219.
4. Werdan K, Gielen S, Ebelt H, Hochman JS. Mechanical circulatory support in cardiogenic shock. Eur Heart J. 2014; 35:156–167.
Article
5. Thiele H, Zeymer U, Neumann FJ, et al. Intraaortic balloon support for myocardial infarction with cardiogenic shock. N Engl J Med. 2012; 367:1287–1296.
Article
6. Kagawa E, Dote K, Kato M, et al. Should we emergently revascularize occluded coronaries for cardiac arrest?: rapid-response extracorporeal membrane oxygenation and intra-arrest percutaneous coronary intervention. Circulation. 2012; 126:1605–1613.
7. Tsao NW, Shih CM, Yeh JS, et al. Extracorporeal membrane oxygenation-assisted primary percutaneous coronary intervention may improve survival of patients with acute myocardial infarction complicated by profound cardiogenic shock. J Crit Care. 2012; 27:530.e1–530.11.
Article
8. Wu MY, Tseng YH, Chang YS, Tsai FC, Lin PJ. Using extracorporeal membrane oxygenation to rescue acute myocardial infarction with cardiopulmonary collapse: the impact of early coronary revascularization. Resuscitation. 2013; 84:940–945.
Article
9. Chung SY, Tong MS, Sheu JJ, et al. Short-term and long-term prognostic outcomes of patients with ST-segment elevation myocardial infarction complicated by profound cardiogenic shock undergoing early extracorporeal membrane oxygenator-assisted primary percutaneous coronary intervention. Int J Cardiol. 2016; 223:412–417.
Article
10. Park TK, Yang JH, Choi SH, et al. Clinical outcomes of patients with acute myocardial infarction complicated by severe refractory cardiogenic shock assisted with percutaneous cardiopulmonary support. Yonsei Med J. 2014; 55:920–927.
Article
11. Chen YS, Lin JW, Yu HY, et al. Cardiopulmonary resuscitation with assisted extracorporeal life-support versus conventional cardiopulmonary resuscitation in adults with in-hospital cardiac arrest: an observational study and propensity analysis. Lancet. 2008; 372:554–561.
Article
12. Shin TG, Choi JH, Jo IJ, et al. Extracorporeal cardiopulmonary resuscitation in patients with inhospital cardiac arrest: a comparison with conventional cardiopulmonary resuscitation. Crit Care Med. 2011; 39:1–7.
Article
13. Thygesen K, Alpert JS, Jaffe AS, et al. Third universal definition of myocardial infarction. Circulation. 2012; 126:2020–2035.
Article
14. Yip HK, Wu CJ, Chang HW, et al. Comparison of impact of primary percutaneous transluminal coronary angioplasty and primary stenting on short-term mortality in patients with cardiogenic shock and evaluation of prognostic determinants. Am J Cardiol. 2001; 87:1184–1188.
Article
15. Hochman JS, Sleeper LA, White HD, et al. One-year survival following early revascularization for cardiogenic shock. JAMA. 2001; 285:190–192.
Article
16. Hochman JS, Sleeper LA, Webb JG, et al. Early revascularization and long-term survival in cardiogenic shock complicating acute myocardial infarction. JAMA. 2006; 295:2511–2515.
Article
17. Sheu JJ, Tsai TH, Lee FY, et al. Early extracorporeal membrane oxygenator-assisted primary percutaneous coronary intervention improved 30-day clinical outcomes in patients with ST-segment elevation myocardial infarction complicated with profound cardiogenic shock. Crit Care Med. 2010; 38:1810–1817.
Article
18. Hajbaghery MA, Mousavi G, Akbari H. Factors influencing survival after in-hospital cardiopulmonary resuscitation. Resuscitation. 2005; 66:317–321.
Article
19. Reynolds JC, Frisch A, Rittenberger JC, Callaway CW. Duration of resuscitation efforts and functional outcome after out-of-hospital cardiac arrest: when should we change to novel therapies? Circulation. 2013; 128:2488–2494.
20. Jo IJ, Shin TG, Sim MS, et al. Outcome of in-hospital adult cardiopulmonary resuscitation assisted with portable auto-priming percutaneous cardiopulmonary support. Int J Cardiol. 2011; 151:12–17.
Article
21. Kim DH, Kim JB, Jung SH, Choo SJ, Chung CH, Lee JW. Extracorporeal cardiopulmonary resuscitation: predictors of survival. Korean J Thorac Cardiovasc Surg. 2016; 49:273–279.
Article
22. Flaherty MP, Khan AR, O'Neill WW. Early initiation of impella in acute myocardial infarction complicated by cardiogenic shock improves survival: a meta-analysis. JACC Cardiovasc Interv. 2017; 10:1805–1806.
23. Na SJ, Chung CR, Cho YH, et al. Vasoactive inotropic score as a predictor of mortality in adult patients with cardiogenic shock: medical therapy versus ECMO. Rev Esp Cardiol (Engl Ed). 2018; [Epub ahead of print].
Article
Full Text Links
  • KCJ
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr