Zhongguo quanke yixue (Dec 2023)
A Comparative Study on Clinical Effects of Combined Auxiliary Sequence of VA-ECMO and IABP on Acute Myocardial Infarction Complicated with Cardiogenic Shock
Abstract
Background The mortality of acute myocardial infarction complicated with cardiogenic shock (AMI-CS) is very high, timely and effective circulatory support is essential to save the lives of patients. It is important to explore the clinical efficacy, complications and prognosis of combined auxiliary sequence of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and intra-aortic balloon pumps (IABP) in patients with AMI-CS. Objective To observe the effect of the auxiliary sequence of VA-ECMO and IABP on the therapeutic effect and prognosis of patients with AMI-CS in the combination of VA-ECMO and IABP, explore the causes and significance of changes in relevant indicators, compare the incidence of complications, analyze the factors affecting prognosis, so as to find a relatively safe and effective mechanical circulatory support (MCS) method for patients with AMI-CS. Methods AMI-CS patients who received VA-ECMO combined with IABP in the Department of Intensive Care Medicine of the Second Affiliated Hospital of Zhengzhou University and Fuwai Central China Cardiovascular Hospital from 2021 to 2022 were retrospectively included as the study objects, and all patients were treated with the combined auxiliary mode of VA-ECMO and IABP, and divided into the group A (IABP followed by VA-ECMO, n=42) and group B (VA-ECMO followed by IABP or VA-ECMO combined with IABP at the same time, n=40). Baseline data, clinical indicators, treatment status, related complications and prognosis before, 24 h and 72 h after combination therapy were collected by the electronic medical record system. Results The results of two-factor repeated measures ANOVA showed that there were interactions of time and intergroup on mean arterial pressure (MAP), heart index (CI), arterial blood lactate (Lac), and troponin I (cTnI) (P<0.05). There was no interaction between time and groups on glomerular filtration rate (GFR) and brain natriuretic peptide (BNP) (P>0.05). The main effects of time on MAP, CI, GFR, Lac, cTnI and BNP were significant (P<0.05). The main intergroup effects on CI and GFR were significant (P<0.05) and not significant on MAP, Lac, cTnI and BNP (P>0.05). MAP, CI and GFR at 24 h and 72 h after treatment were higher than those before treatment, while Lac, cTnI and BNP were lower than those before treatment, the differences were statistically significant (P<0.05). CI at 72 h after treatment was higher than 24 h after treatment (P<0.05). Lac, cTnI and BNP at 72 h after treatment were lower than those at 24 h after treatment, the differences were statistically significant (P<0.05). MAP, CI and GFR of the group B were higher than those of group A at 24 h and 72 h after treatment, while Lac and cTnI were lower than those of group A, with significant differences (P<0.05). The proportions of norepinephrine and M-hydroxylamine use in group A were higher than group B (P<0.05). The proportion of acute kidney injury (AKI) in group A was higher than group B, with lower discharge survival rate (P<0.05) . Conclusion Compared to VA-ECMO followed by VA-ECMO, the combined auxiliary sequence of VA-ECMO followed by IABP (or the combination of ECMO and IABP at the same time) is superior in improving hemodynamics, cardiac function, renal function, and tissue perfusion levels, with less use of vasoactive drugs, lower incidence of complication of AKI, higher survival discharge rates, and improved clinical outcomes in patients with AMI-CS.
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