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Standby extracorporeal membrane oxygenation: a better strategy for high-risk percutaneous coronary intervention

Chuang Liu1, Xingxing Li1, Jun Li1

  • 1Department of Extracorporeal Life Support Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.

Frontiers in Medicine
|July 12, 2024
PubMed

Insights

Standby extracorporeal membrane oxygenation (ECMO) during percutaneous coronary intervention (PCI) reduces low-flow time and improves survival for patients experiencing cardiac arrest (CA). This approach is beneficial for high-risk PCI cases.

Area of Science:

  • Cardiology
  • Intensive Care Medicine
  • Interventional Cardiology

Background:

  • Cardiac arrest (CA) during percutaneous coronary intervention (PCI) has a high mortality rate.
  • Extracorporeal cardiopulmonary resuscitation (ECPR) improves survival for in-hospital cardiac arrests (IHCA).
  • Reducing low-flow time is crucial for CA patient survival, but methods are not well-defined.

Purpose of the Study:

  • To evaluate the impact of standby extracorporeal membrane oxygenation (ECMO) on outcomes for patients undergoing ECPR during PCI.
  • To compare low-flow time, mortality, and other factors between standby ECPR (SBE) and extemporaneous ECPR (EE) cohorts.

Main Methods:

  • Retrospective single-center study of 39 patients undergoing ECPR during PCI (January 2016 - December 2022).
  • Patients divided into SBE (n=13) and EE (n=26) cohorts.
  • Comparison of 30-day mortality, low-flow time, ECMO operation time, acute kidney injury (AKI), peak lactate, and SYNTAX II score.

Main Results:

  • The SBE cohort had significantly lower low-flow time, ECMO operation time, peak lactate, and incidence of AKI compared to the EE cohort.
  • Standby ECMO was associated with improved 30-day survival (p=0.036).
  • Prolonged low-flow time (p=0.004) and higher SYNTAX II score (p=0.062) predicted 30-day mortality.

Conclusions:

  • Standby ECMO offers significant benefits for patients undergoing ECPR for CA during PCI.
  • This strategy is a viable option for high-risk PCI, potentially enhancing prognosis.
  • Low-flow time remains a critical determinant of survival in these patients.
Abstract

Keywords:
cardiac arrestextracorporeal cardiopulmonary resuscitationlow-flow timepercutaneous coronary interventionstandby extracorporeal membrane oxygenation

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