Key result
Post-PCI TIMI flow, early MAP, and 24-hour lactate independently predict successful VA-ECMO weaning.
Why the study?
Predicting successful weaning from VA-ECMO in patients with AMI complicated by cardiac arrest is essential to guide further treatment strategies including use of ventricular assist devices.
Observational (n=55)
Yes
Answers are grounded in this paper and cite their sources.
Retrospective multicenter study reveals early predictors of successful VA-ECMO weaning in post-cardiac arrest myocardial infarction, indicating when advanced mechanical support is needed.
AIM: While veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been utilized to resuscitate and stabilize hemodynamics in patients of acute myocardial infarction (AMI) complicated by cardiac arrest (CA), it is essential to predict the possibility of weaning from ECMO to determine further strategies, including use of ventricular assist device. We aimed to determine predictors of successful weaning from VA-ECMO in the early phase of ECMO treatment. METHODS: We identified consecutive patients of AMI complicated by CA treated with VA-ECMO and percutaneous coronary intervention (PCI). Clinical data within 48 h after ECMO initiation were assessed and multiple logistic regression analysis was performed to determine independent predictors of weaning outcome. RESULTS: Fifty-five patients were analyzed. While 28 (51%) patients were successfully weaned from VA-ECMO, 27 (49%) failed to wean. Multivariate analysis identified post-PCI thrombolysis in myocardial infarction (TIMI) flow grade (P = 0.046), mean arterial pressure (MAP) at 4 h after ECMO initiation (P = 0.010), and serum lactate at 24 h (P = 0.015) as independent predictors of successful weaning. Left ventricular ejection fraction (LVEF) at 24 and 48 h was significantly greater in the successful weaning group (P = 0.014, P = 0.025, respectively). CONCLUSIONS: Successful weaning from VA-ECMO was predicted by post-PCI TIMI flow grade, MAP at 4 h, and serum lactate at 24 h after VA-ECMO initiation in patients of AMI complicated by CA. Furthermore, in patients who failed to wean from ECMO, LVEF did not recover within 48 h. In such patients, adjunctive use of other circulatory mechanical devices must be considered.
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Sugiura et al. (2018) conducted an observational in Acute Myocardial Infarction complicated by Cardiac Arrest (n=55). Post-PCI TIMI flow grade, mean arterial pressure at 4 hours, and serum lactate at 24 hours was evaluated on Successful weaning from VA-ECMO. Post-PCI TIMI flow grade (P=0.046), MAP at 4 hours (P=0.010), and serum lactate at 24 hours (P=0.015) independently predicted successful weaning from VA-ECMO, which was achieved in 51% of patients.
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