Study Of The Application Of ECMO In Patients With Cardiogenic Shock

Objective:To investigate the efficacy of extracorporeal membrane pulmonary oxygenation(ECMO)in patients with cardiogenic shock.Methods:A retrospective analysis of 22 patients with cardiogenic shock who received adjuvant ECMO therapy in Yijishan Hospital affiliated to Wannan Medical College from October 2019 to October 2021,among them,12(54.5%)cases were males,aged 56.59±8.53 years old.According to the etiology of cardiogenic shock,they were divided into acute myocardial infarction group,14 cases,10 male cases(71.4%),aged 58.71 ±8.84 years;fulminant myocarditis Group 8 cases,2 males(25.0%),age 52.88±6.94 years old.The clinical baseline data and related clinical data before and after ECMO treatment in the two groups were analyzed to observe the effect of ECMO treatment on patients with cardiogenic shock caused by acute myocardial infarction and fulminant myocarditis.Results:A total of 22 patients with cardiogenic shock treated with ECMO were included in this study,including 12(54.5%)males,10(45.5%)females,19(86.4%)patients who were successfully weaned off,and 18(81.8%)patients who survived in the hospital..Among them,there were 14 cases in the acute myocardial infarction group,10(71.4%)cases were males,11(78.6%)cases were successfully weaned off of the total acute myocardial infarction cases,and 11(78.6%)cases survived in the hospital.In the acute myocardial infarction group,13 patients underwent emergency PCI after admission to our hospital,and 1 patient was transferred to our hospital for further treatment after PCI in another hospital because the postoperative circulation could not be maintained.Among the 13 patients who underwent emergency PCI in our hospital.The lesions included 1 case of LM,5 cases of LAD,2 cases of RCA,2 cases of LAD and RCA,2 cases of LAD and LCX,and 1 case of coronary spasm.Among the 13 patients undergoing emergency PCI,11 patients were successfully opened with diseased blood vessels.One patient was forced to terminate the operation due to the difficulty of the operation and the patient’s overall condition was poor.The other patient did not receive special treatment because of vasospasm.In the 14 patients with acute myocardial infarction,ECMO was used in 4 cases during PCI,and 10 cases were used after PCI because the circulation could not be maintained.There were 8 cases in the fulminant myocarditis group,2 cases(25.0%)were males,and 8 cases(100.0%)were successfully weaned off,and 7(87.5%)cases survived in the hospital.There were no significant differences in gender,age,underlying disease,combined IABP and CRRT,and ECMO-assisted duration between the two groups(P>0.05).Among the patients in the acute myocardial infarction group,IABP7(50.0%)was used,and CRRT3(21.4%)was used.ECMO adjuvant time was 123.58±57.96 hours,fulminant myocarditis was treated with IABP7(87.5%)cases,CRRT1(12.5%)case,and ECMO adjuvant time was 152.64±56.59 hours.After ECMO treatment,the circulatory status、CK,、CK-MB、cTnI、AST、serum creatinine、LDH and APACHEⅡ scores in the two groups were significantly improved compared with those before treatment,and the difference was statistically significant(P<0.05).There was no difference in the situation(P>0.05).Among them,in the fulminant myocarditis group,BNP was slightly higher after treatment than before treatment,but the difference was not statistically significant(P=0.674),and there was no significant difference in blood urea before and after treatment(P=0.151).Compared with the fulminant myocarditis group,the acute myocardial infarction group improved more significantly after treatment(P=0.035)in BNP.There was no significant difference in the incidence of complications such as bleeding,、infection、embolism,、MODSand AKI between the two groups(P>0.05).There was no statistical difference in the smooth weaning and in-hospital survival between the two groups(P>0.05).Conclusion:This study shows that ECMO is effective for acute myocardial infarction or fulminant myocarditis combined with cardiogenic shock;the overall evaluation index of ECMO efficacy has no significant difference between the acute myocardial infarction group and the fulminant myocarditis group.