Objective: To explore the safety and efficacy of venous-arterial extracorporeal membrane oxygenation (VA-ECMO) in complex high-risk and indicated patients (CHIP). Methods: This is a single-center retrospective study. Patients who underwent percutaneous coronary intervention (PCI) supported by VA-ECMO in the Second Hospital of Jilin University from June 2018 to January 2020 were enrolled. General clinical data, laboratory examination results, PCI and ECMO process, postoperative complications and prognosis were collected through the electronic medical record system. The endpoint of the study was major adverse cardiovascular events (MACE), defined as complex events including cardiac death, recurrent myocardial infarction, heart failure and malignant arrhythmia. All patients were followed up for 12 months after discharge. Kaplan-Meier method was used for survival analysis. Results: A total of 31 patients, aged (64.6±10.1) years, including 19 males were included. All patients were treated with VA-ECMO before PCI. The ProGlide vascular suture device was embedded by local anesthesia to quickly establish circulation. There were 9 (29.0%) patients with ST-segment elevation myocardial infarction, 10 (32.3%) patients with non-ST-segment elevation myocardial infarction and 12 (38.7%) patients with unstable angina. The number of stents implanted during the operation were 2.8±1.8. The VA-ECMO weaning time was 24.0 (2.0, 88.5) hours. Compared with the results of pre-operation, the patient's postoperative left ventricular ejection fraction was significantly improved (49% (42%, 55%) vs. 43% (35%, 52%), P<0.01], hemoglobin and platelet count levels decreased, the level of creatinine and urea nitrogen was increased (P<0.05). Within 24 hours after operation, hemoglobin decreased>20 g/L was observed in 18 cases (58.1%), puncture site bleeding was found in 2 cases (6.5%), pseudoaneurysm occurred in 1 case (3.2%) and postoperative cerebral infarction occurred in 1 case (3.2%). There were no deaths during the operation, 2 patients died during hospitalization. All discharged patients were followed up for 12 months. The incidence of MACE was 13.8% (4/29). During the follow-up period, 2 patients died. One patient was hospitalized with recurrent myocardial infarction and one patient with heart failure. Survival analysis was performed 12 months after intervention and the cumulative survival rate was 80.0%. Conclusion: The application of VA-ECMO in CHIP interventional therapy is safe, effective and feasible.
目的： 探讨动-静脉体外膜肺氧合（VA-ECMO）在冠状动脉病变复杂高危有介入治疗指征患者（CHIP）中的应用价值。 方法： 该研究为单中心回顾性研究，纳入2018年6月至2020年1月吉林大学第二医院收治的行VA-ECMO循环辅助经皮冠状动脉介入治疗（PCI）的患者。收集患者的一般临床资料、实验室检验结果、PCI经过、ECMO辅助治疗过程、术后并发症及预后。研究终点为主要不良心血管事件（MACE），定义为包括心原性死亡、再发性心肌梗死、心力衰竭及恶性心律失常的复合事件。随访患者出院后12个月终点事件发生情况，采用Kaplan-Meier法进行生存分析。 结果： 本研究共入选31例患者，年龄（64.6±10.1）岁，其中男性19例。纳入患者均于术前辅助应用VA-ECMO、局部麻醉下预埋ProGlide血管缝合器迅速建立循环。其中，ST段抬高型心肌梗死患者9例（29.0%）、非ST段抬高型心肌梗死10例（32.3%）、不稳定性心绞痛12例（38.7%）。术中置入支架（2.8±1.8）枚，VA-ECMO撤机时间为［24.0（2.0，88.5）］h。与术前检查结果相比，患者术后左心室射血分数明显改善［49%（42%，55%）比43%（35%，52%），P<0.01］，血红蛋白及血小板计数水平均降低，肌酐及尿素氮水平升高（P均<0.05）。术后24 h内血红蛋白下降>20 g/L者18例（58.1%），穿刺处渗血2例（6.5%），假性动脉瘤1例（3.2%），术后新发脑梗死1例（3.2%）。术中无死亡病例，院内死亡2例。所有患者术后均完成了12个月的随访，MACE事件的发生率为13.8%（4/29），其中死亡2例，再发心肌梗死入院1例，心力衰竭1例。生存分析结果显示，术后12个月的累积生存率为80.0%。 结论： CHIP介入治疗中应用VA-ECMO安全有效，具有可行性。.