BACKGROUND Extracorporeal membrane oxygenation (ECMO) is increasingly used in acute myocardial infarction (AMI); however, there are limited large-scale national data. METHODS Using the National Inpatient Sample database from 2000 to 2014, a retrospective cohort of AMI utilizing ECMO was identified. Use of percutaneous coronary intervention, intra-aortic balloon pump, and percutaneous left ventricular assist device (LVAD) was also identified in this population. Outcomes of interest included temporal trends in utilization of ECMO alone and with concomitant procedures (percutaneous coronary intervention, intra-aortic balloon pump, and percutaneous LVAD), in-hospital mortality, and resource utilization. RESULTS In ≈9 million AMI admissions, ECMO was used in 2962 (<0.01%) and implanted a median of 1 day after admission. ECMO was used in 0.5% and 0.3% AMI admissions complicated by cardiogenic shock and cardiac arrest, respectively. ECMO was used more commonly in admissions that were younger, nonwhite, and with less comorbidity. ECMO use was 11× higher in 2014 as compared with 2000 (odds ratio, 11.37 [95% CI, 7.20-17.97]). Same-day percutaneous coronary intervention was performed in 23.1%; intra-aortic balloon pump/percutaneous LVAD was used in 57.9%, of which 30.3% were placed concomitantly. In-hospital mortality with ECMO was 59.2% overall but decreased from 100% (2000) to 45.1% (2014). Durable LVAD and cardiac transplantation were performed in 11.7% as an exit strategy. Of the hospital survivors, 40.8% were discharged to skilled nursing facilities. Older age, male sex, nonwhite race, and lower socioeconomic status were independently associated with higher in-hospital mortality with ECMO use. CONCLUSIONS In AMI admissions, a steady increase was noted in the utilization of ECMO alone and with concomitant procedures (percutaneous coronary intervention, intra-aortic balloon pump, and percutaneous LVAD). In-hospital mortality remained high in AMI admissions treated with ECMO.

中文翻译：

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2000年至2014年，美国急性心肌梗死的体外膜氧合作用。

背景技术体外膜氧合（ECMO）越来越多地用于急性心肌梗塞（AMI）中。但是，大规模的国家数据有限。方法使用2000年至2014年的美国国家住院患者样本数据库，对使用ECMO的AMI进行回顾性研究。在该人群中还发现了经皮冠状动脉介入治疗，主动脉内气囊泵和经皮左心室辅助装置（LVAD）的使用。感兴趣的结果包括单独使用ECMO及其伴随程序（经皮冠状动脉介入治疗，主动脉内球囊泵和经皮LVAD）的暂时趋势，院内死亡率和资源利用情况。结果在约900万例AMI入院中，有2962例使用ECMO（<0.01％），并在入院后1天植入了中位数。ECMO的使用率为0.5％和0。AMI入院率分别为3％，并伴有心源性休克和心脏骤停。ECMO更常用于年轻，非白人，合并症较少的患者。与2000年相比，2014年ECMO使用量增加了11倍（赔率为11.37 [95％CI，7.20-17.97]）。当天经皮冠状动脉介入治疗的发生率为23.1％；主动脉内球囊泵/经皮LVAD的使用率为57.9％，其中30.3％是同时放置的。ECMO的院内死亡率总体为59.2％，但从100％（2000）降至45.1％（2014）。持久性LVAD和心脏移植的退出策略为11.7％。在医院幸存者中，有40.8％的人被送到了熟练的护理机构。年龄较大，男性，非白人，和较低的社会经济地位与使用ECMO的较高的院内死亡率独立相关。结论在AMI入院时，单独使用ECMO及其伴随的程序（经皮冠状动脉介入治疗，主动脉内球囊泵和经皮LVAD）的使用率稳步上升。ECMO治疗的AMI住院患者的院内死亡率仍然很高。