Key result
VA-ECMO linked to ~44 percentage point lower risk of multiple organ failure vs. IABP in high-risk PCI.
Why the study?
The organoprotective effects of veno-arterial ECMO versus intra-aortic balloon pump during high-risk PCI in acute coronary syndrome patients were not well established.
Observational (n=51)
No
May warrant VA-ECMO consideration for organ protection in high-risk PCI; leaves open confirmation in randomized trials.
Purpose of the study: to evaluate the organoprotective effects of veno-arterial extracorporeal membrane oxygenation and intra-aortic balloon pump during high-risk percutaneous coronary intervention in acute coronary syndrome. Materials and methods. Patients required mechanical circulatory support (n=51) were divided into two study groups: patients who received mechanical circulatory support by veno-arterial extracorporeal membrane oxygenation (ECMO) (Group 1, n=29) during high-risk percutaneous coronary intervention, and Group 2 patients who received mechanical circulatory support by intra-aortic balloon pump (IABP) during high-risk percutaneous coronary intervention (Group 2, n=22). The dynamics of instrumental parameters and laboratory markers of organ damage were evaluated by electrocardiography, echocardiography, determining troponin I, creatine phosphokinases and creatinine levels, NGAL, venous blood saturation to compare the organoprotective properties of mechanical circulation support in the intra- and postoperative period. Results. The following values of the parameters were found the next day after the intervention: troponin I — 0.18 (0.1; 2.3) ng/ml in the ECMO group and 1.64 (0.92; 2.36) ng/ml in the IABP group (P=0.045); serum NGAL —139.4 (88.1; 166.7) ng/ml in the ECMO group and 212.3 (102; 279) in the IABP group (P=0.027); renal dysfunction (stages R, I, F according to RIFLE) — 2 (6.8%) observations in the ECMO group and 7 (31.8%) in the IABP group (P=0.021); multiple organ failure (2 or more points according to SOFA) — 3 (10.3%) cases in the ECMO group and 12 (54.5%) in the IABP group (P=0.001). Conclusion. Veno-arterial ECMO in comparison with IABP has a more pronounced organoprotective effect by achieving better hemodynamic stability, which, in turn, prevents hypoxia and the subsequent development of organ dysfunction. In addition, in conditions of veno-arterial ECMO, better completeness and quality of revascularization is ensured, and hospital mortality is also reduced.
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KORNELYUK et al. (2020) conducted an observational in Acute coronary syndrome requiring high-risk percutaneous coronary intervention (n=51). Veno-arterial extracorporeal membrane oxygenation (VA ECMO) vs. Intra-aortic balloon pump (IABP) was evaluated on Multiple organ failure (≥2 points by SOFA score) (p=0.001). Veno-arterial extracorporeal membrane oxygenation significantly reduced the incidence of multiple organ failure to 10.3% compared to 54.5% with an intra-aortic balloon pump during high-risk percutaneous coronary intervention.
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