Korean Circ J.  2021 Jun;51(6):533-544. 10.4070/kcj.2020.0499.

Benefit of Extracorporeal Membrane Oxygenation before Revascularization in Patients with Acute Myocardial Infarction Complicated by Profound Cardiogenic Shock after Resuscitated Cardiac Arrest

• Kim MC
• Ahn Y
• Cho KH
• Sim DS
• Hong YJ
• Kim JH
• Jeong MH
• Cho JG
• Kim D
• Lee K
• Jeong I
• Cho YS
• Jung YH
• Jeung KW

• KMID: 2516215
• DOI: http://doi.org/10.4070/kcj.2020.0499

Abstract

Background and Objectives
The study sought to investigate the impact of early extracorporeal membrane oxygenation (ECMO) support before revascularization in patients with acute myocardial infarction (AMI) complicated by profound cardiogenic shock after resuscitated cardiac arrest. It is difficult to determine optimal timing of ECMO in patients with AMI complicated by profound cardiogenic shock after resuscitated cardiac arrest.
Methods
Among 116,374 patients experiencing out-of-hospital cardiac arrest in South Korea, a total of 184 resuscitated patients with AMI complicated by profound cardiogenic shock, and who were treated successfully with percutaneous coronary intervention (PCI) and ECMO, were enrolled. Patients were divided into 2 groups according to the timing of ECMO: pre-PCI ECMO (n=117) and post-PCI ECMO (n=67). We compared 30-day mortality between the 2 groups.
Results
In-hospital mortality was 78.8% in the entire study population and significantly lower in the pre-PCI ECMO group (73.5% vs. 88.1%, p=0.020). Thirty-day mortality was also lower in the pre-PCI ECMO group compared to the post-PCI ECMO group (74.4% vs. 91.0%; adjusted hazard ratio [HR], 0.66; 95% confidence interval [CI], 0.47–0.93; p=0.017). Shockable rhythm at the emergency room (HR, 0.57; 95% CI, 0.36–0.91; p=0.019) and successful therapeutic hypothermia (HR, 0.40; 95% CI, 0.23–0.69; p=0.001) were also associated with improved 30-day survival.
Conclusions
ECMO support before revascularization was associated with an improved short-term survival rate compared to ECMO after revascularization in patients with AMI complicated by profound cardiogenic shock after resuscitated cardiac arrest.

Keyword

Myocardial infarction; Extracorporeal membrane oxygenation; Cardiogenic shock; Out-of-hospital cardiac arrest

Figure

• 

  Figure 1 Study flowchart.AMI = acute myocardial infarction; CPR = cardiopulmonary resuscitation; ECMO = extracorporeal membrane oxygenation; EMS = emergency medical services; ER = emergency room; OHCA = out-of-hospital cardiac arrest; PCI = percutaneous coronary intervention; ROSC = return of spontaneous circulation.

• 

  Figure 2 Incidences of study endpoints (A), and Kaplan-Meier estimates of cumulative probabilities of 30-day death for patients according to ECMO timing (B).ECMO = extracorporeal membrane oxygenation; PCI = percutaneous coronary intervention.*Defined as scoring 1 or 2 on the cerebral performance category score.

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