Background

Mortality for patients on veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for cardiogenic shock (CS) complicating acute myocardial infarction (AMI) remains high. This meta-analysis aims to identify factors that predict higher risk of mortality after VA-ECMO for AMI.

Methods

We meta-analyzed mortality after VA-ECMO for CS complicating AMI and the effect of factors from systematically selected studies published after 2009.

Results

72 studies (10,276 patients) were included with a pooled mortality estimate of 58 %. With high confidence in estimates, failure to achieve TIMI III flow and left main culprit were identified as factors associated with higher mortality. With low-moderate confidence, older age, high BMI, renal dysfunction, increasing lactate, prothrombin activity < 50%, VA-ECMO implantation after revascularization, and non-shockable ventricular arrythmias were identified as factors associated with mortality.

Conclusion

These results provide clinicians with a framework for selecting patients for VA-ECMO for CS complicating AMI.

中文翻译：

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急性心肌梗死并发心源性休克接受静脉-动脉 ECMO 治疗的患者死亡率的预测因素：系统评价和荟萃分析

背景

因心源性休克 (CS) 并发急性心肌梗死 (AMI) 的静脉-动脉体外膜肺氧合 (VA-ECMO) 患者的死亡率仍然很高。这项荟萃分析旨在确定预测 AMI VA-ECMO 后死亡风险较高的因素。

方法

我们荟萃分析了 VA-ECMO 后 CS 并发 AMI 的死亡率以及 2009 年之后发表的系统选择研究的因素的影响。

结果

纳入 72 项研究（10,276 名患者），合并死亡率估计为 58%。由于对估计的置信度很高，未能达到 TIMI III 流量和左主要罪魁祸首被确定为与较高死亡率相关的因素。中低置信度、高龄、高 BMI、肾功能不全、乳酸增加、凝血酶原活性 < 50%、血运重建后 VA-ECMO 植入和不可电击室性心律失常被确定为与死亡率相关的因素。

结论

这些结果为临床医生选择 VA-ECMO 治疗 CS 并发 AMI 患者提供了一个框架。