Background: Extracorporeal membrane oxygenation (ECMO) is increasingly used in acute myocardial infarction (AMI); however, there are limited large-scale national data.
Methods: Using the National Inpatient Sample database from 2000 to 2014, a retrospective cohort of AMI utilizing ECMO was identified. Use of percutaneous coronary intervention, intra-aortic balloon pump, and percutaneous left ventricular assist device (LVAD) was also identified in this population. Outcomes of interest included temporal trends in utilization of ECMO alone and with concomitant procedures (percutaneous coronary intervention, intra-aortic balloon pump, and percutaneous LVAD), in-hospital mortality, and resource utilization.
Results: In ≈9 million AMI admissions, ECMO was used in 2962 (<0.01%) and implanted a median of 1 day after admission. ECMO was used in 0.5% and 0.3% AMI admissions complicated by cardiogenic shock and cardiac arrest, respectively. ECMO was used more commonly in admissions that were younger, nonwhite, and with less comorbidity. ECMO use was 11× higher in 2014 as compared with 2000 (odds ratio, 11.37 [95% CI, 7.20-17.97]). Same-day percutaneous coronary intervention was performed in 23.1%; intra-aortic balloon pump/percutaneous LVAD was used in 57.9%, of which 30.3% were placed concomitantly. In-hospital mortality with ECMO was 59.2% overall but decreased from 100% (2000) to 45.1% (2014). Durable LVAD and cardiac transplantation were performed in 11.7% as an exit strategy. Of the hospital survivors, 40.8% were discharged to skilled nursing facilities. Older age, male sex, nonwhite race, and lower socioeconomic status were independently associated with higher in-hospital mortality with ECMO use.
Conclusions: In AMI admissions, a steady increase was noted in the utilization of ECMO alone and with concomitant procedures (percutaneous coronary intervention, intra-aortic balloon pump, and percutaneous LVAD). In-hospital mortality remained high in AMI admissions treated with ECMO.
Keywords: heart arrest; outcome assessment (health care); patient discharge; shock, cardiogenic; survivors.
Mechanical Circulatory Support-Assisted Early Percutaneous Coronary Intervention in Acute Myocardial Infarction with Cardiogenic Shock: 10-Year National Temporal Trends, Predictors and Outcomes.EuroIntervention. 2019 Nov 19:EIJ-D-19-00226. doi: 10.4244/EIJ-D-19-00226. Online ahead of print. EuroIntervention. 2019. PMID: 31746759
Trends in mechanical circulatory support use and hospital mortality among patients with acute myocardial infarction and non-infarction related cardiogenic shock in the United States.Clin Res Cardiol. 2018 Apr;107(4):287-303. doi: 10.1007/s00392-017-1182-2. Epub 2017 Nov 13. Clin Res Cardiol. 2018. PMID: 29134345
Association of Use of an Intravascular Microaxial Left Ventricular Assist Device vs Intra-aortic Balloon Pump With In-Hospital Mortality and Major Bleeding Among Patients With Acute Myocardial Infarction Complicated by Cardiogenic Shock.JAMA. 2020 Feb 10:e200254. doi: 10.1001/jama.2020.0254. Online ahead of print. JAMA. 2020. PMID: 32040163
Lack of Survival Benefit Found With Use of Intraaortic Balloon Pump in Extracorporeal Membrane Oxygenation: A Pooled Experience of 1517 Patients.J Invasive Cardiol. 2015 Oct;27(10):453-8. Epub 2015 Jul 15. J Invasive Cardiol. 2015. PMID: 26208379 Review.
Use of left ventricular support devices during acute coronary syndrome and percutaneous coronary intervention.Curr Cardiol Rep. 2014 Dec;16(12):544. doi: 10.1007/s11886-014-0544-x. Curr Cardiol Rep. 2014. PMID: 25326728 Review.
Cited by 1 article
Complications in Patients with Acute Myocardial Infarction Supported with Extracorporeal Membrane Oxygenation.J Clin Med. 2020 Mar 19;9(3):839. doi: 10.3390/jcm9030839. J Clin Med. 2020. PMID: 32204507 Free PMC article.