RISK FACTORS FOR DEATH AND OUTCOME AFTER PROMPT EXTRACORPOREAL LIFE SUPPORT IN ACUTE MYOCARDIAL INFARCTION WITH CARDIOGENIC SHOCK MD Ciro Mastroianni and Pr Pascal Leprince Institut de cardiologie Chirurgie cardiaque Groupe Hospitalier Pitié-Salpêtrière Assistance Publique Hôpitaux de Paris Paris, France
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MD Ciro Mastroianni and Pr Pascal Leprince Institut de cardiologie Chirurgie cardiaque
RISK FACTORS FOR DEATH AND OUTCOME AFTER PROMPT EXTRACORPOREAL LIFE SUPPORT IN ACUTE MYOCARDIAL INFARCTION WITH CARDIOGENIC SHOCK. MD Ciro Mastroianni and Pr Pascal Leprince Institut de cardiologie Chirurgie cardiaque Groupe Hospitalier Pitié-Salpêtrière - PowerPoint PPT Presentation
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RISK FACTORS FOR DEATH AND OUTCOME AFTER PROMPT EXTRACORPOREAL LIFE
SUPPORT IN ACUTE MYOCARDIAL INFARCTION WITH CARDIOGENIC SHOCK
MD Ciro Mastroianni and Pr Pascal LeprinceInstitut de cardiologieChirurgie cardiaque
Groupe Hospitalier Pitié-SalpêtrièreAssistance Publique Hôpitaux de Paris
Paris, France
Between February 2006 and November 2009
745 ECLS V-V and V-A 77 ECLS support for AMI with CS
- 59 peripheral - 18 central
67% after PCA or cardiac surgery
Demographics and comorbidity
Age (years) (mean ± SD) 56.05 ± 0.70
Male gender % (n) 75.32 (58)
Body mass index (mean ±
SD)
25.81 ± 4.82
Diabetes mellitus % (n) 28.94 (22)
Hypertension % (n) 26.30 (20)
Current smoking % (n) 46.05 (35)
Hypercholesterolemia % (n) 34.20 (26)
Previous cardiac surgery %
(n)
5.30 (4)
Haemodynamics data
Left ventricular ejection fraction (%)
(mean ± SD)
17 ± 7
Mean blood pressure (mmHg) (mean ±
SD)
52.4 ±
14.10
Intra-aortic balloon pump support % (n) 55.80 (43)
Previous cardiopulmonary resuscitation %
(n)
40.30 (31)
ECLS implantation under cardiac massage
% (n)
18.20 (14)
Laboratory data pre-implantation
Creatinine (µmol/l) (mean ± SD) 158.07 ±
81.57
SGOT (UI/l) (mean ± SD) 1339.35 ±
2233.52
Prothrombin time (%) (mean ± SD) 50,02 ± 21.13
Lactate (mmol/l) (mean ± SD) 8.38 ± 4.87
Peak level of Troponin-I (µg/l) (mean
± SD)
286.08 ±
706.37
Inotropes at ECLS implantation
Strategy
ECLS implantation to provide immediate circulatory support for hemodynamic stabilization
Patients who had no signs of recovery after 3 weeks were considered candidates for:
transplantation LVAD implantation
ECLS weaning
pulsatile arterial waveform MBP >60 mmHg while receiving no or low-
dose vasoactive agents good pulmonary blood oxygenation
ECLS flow decreased progressively
LVEF ≥ 25%ITV ≥ 12 cm
Causes of death
Causes of death
Multivariate analysis of 30 days mortality risk factors
Traitement of pulmonary edema during peripheral ECLS
Inotropes IABP
Impella LP 2.5 and 5.0
Central ECLS
Double Central ECLS
Conclusions
Prompt ECLS support is an effective management and provides a reasonable chance of survival in much compromised patient with AMI associated with profound CS
Reducing the duration of end organs ischemia is the keystone of management for these patients