Long-term survival with use of percutaneous extracorporeal life support in patients presenting with acute myocardial infarction and cardiovascular collapse
Long-term survival with use of percutaneous extracorporeal life support in patients presenting with acute myocardial infarction and cardiovascular collapse
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DOI：
10.1097/00002480-199911000-00018
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发表时间：
1999-11-01
期刊：
影响因子：
4.2
通讯作者：
Dembitsky, WP
中科院分区：
文献类型：
--
作者：
Jaski, BE;Lingle, RJ;Dembitsky, WP
高达10%的急性心肌梗死（AMI）患者入院时存在或发展为心源性休克。一些患者，尽管正性肌力药物和主动脉内球囊反搏（IABP）放置，血流动力学不稳定，足以进行紧急血运重建。使用经皮体外生命支持（ECLS）可以稳定患者，以便进行有效治疗。在对Sharp Memorial Hospital通过护士支持的医生插入技术紧急置入ECLS的前100例患者进行的回顾性审查中，10例患者在院外AMI后接受了ECLS置入。所有AMI患者在开始ECLS前均需要插管治疗呼吸衰竭和临时CPR治疗心血管衰竭。在接受ECLS治疗的10例AMI患者中，4例（40%）目前为长期存活者（5.1 +/- 4.2年;范围：6个月至11年）。所有存活者在放置ECLS后均成功进行了血运重建。其他6例患者的死亡原因是2例神经功能不全，2例ECLS无效，2例从旁路脱机后复发性心血管虚脱。心肺转流术开始前，存活者的总心肺复苏时间为17 ± 10.3分钟，死亡者为54.2 ± 11.1分钟（p < 0.001）。存活者的ECLS平均时间为29 +/- 26小时，非存活者为30 +/- 67小时（p = NS）。腿部并发症在长期存活者中很常见，与ECLS的使用有关（3例缺血，1例感染）。在AMI和心血管衰竭后，插入ECLS可使患者长期存活。
Up to 10% of patients who arrive at the hospital with acute myocardial infarction (AMI) present with or develop cardiogenic shock. Some patients, despite inotropes and intra-aortic balloon pump (IABP) placement, are not hemodynamically stable enough to undergo emergent revascularization. The use of percutaneous extracorporeal life support (ECLS) can stabilize patients to allow effective therapy. In a retrospective review of the first 100 patients emergently placed on ECLS by a nurse-supported physician insertion technique at Sharp Memorial Hospital, 10 patients underwent placement of ECLS after out-of hospital AMI. All AMI patients required intubation for respiratory failure and temporary CPR for cardiovascular collapse before initiation of ECLS. Of the 10 AMI patients placed on ECLS, four (40%) are currently long-term survivors (5.1 +/- 4.2 years; range, 6 months to 11 years). All survivors underwent successful revascularization after placement on ECLS. The cause of death in the other six patients was neurologic insufficiency in two, ineffective ECLS in two, and recurrent cardiovascular collapse after weaning from bypass in two. Total CPR time before initiation of cardiopulmonary bypass was 17 +/- 10.3 minutes for the survivors and 54.2 +/- 11.1 minutes for the nonsurvivors (p < 0.001). The average time on ECLS was 29 +/- 26 hours for the survivors and 30 +/- 67 hours for the nonsurvivors (p = NS). Leg complications were common among long-term survivors, associated with the use of ECLS (three ischemia, one infection). After AMI and cardiovascular collapse, insertion of ECLS may permit longterm patient survival.