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BACKGROUND AND METHODS: Cardiogenic shock remains one of the leading causes of death in patients with myocardial infarction. The Intra-aortic balloon pump (IABP) has been widely used as a treatment for acute myocardial infarction (AMI), despite recommendations against its routine use. In this paper, our aim is to analyze and share our own experience with IABP in the setting of AMI. We retrospectively reviewed the files of patients admitted with AMI and cardiogenic shock and for whom IABP was inserted between June 2016 and December 2022. RESULTS: 300 patients with AMI and cardiogenic shock were admitted and benefited from IABP insertion and primary coronary revascularization. The overall mortality rate was 62.3%, the site related complication rate was 0.6%, and the overall complications rate (including site related and major bleeding) was 10.6%. There was a significantly higher mortality in the group of patients where the Left Anterior Descending artery (LAD) was the culprit lesion, in the group of patients who required dialysis, the group who had creatinine levels greater than 200 um/L compared to the group who had creatinine lower than 200 um/L, and in patients older than 70 years. Interestingly, no difference in mortality was observed between men and women, single versus multiple vessel disease, and between STEMI and non-STEMI patients. CONCLUSION: Mortality of AMI complicated by cardiogenic shock and treated by IABP remains high. However, IABP usage is associated with a low complication rate. Better selection criteria for IABP usage versus other more powerful mechanical circulatory support devices in such patients might improve the outcome for the patient.
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A 45 years old female patient was admitted to our facility for COVID -19 infection complicated by fulminant cardiac injury and refractory cardiogemic shock. She had echographic findings of reverse takotsubo cardiomyopathy. She was successfully treated by VA-ECMO allowing complete revocery of the left ventricule function and weaning from support.
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COVID-19 , Oxigenación por Membrana Extracorpórea , Cardiomiopatía de Takotsubo , COVID-19/complicaciones , Oxigenación por Membrana Extracorpórea/efectos adversos , Femenino , Humanos , Persona de Mediana Edad , Choque Cardiogénico/etiología , Choque Cardiogénico/terapia , Cardiomiopatía de Takotsubo/complicaciones , Cardiomiopatía de Takotsubo/terapiaRESUMEN
INTRODUCTION: ECMO provides respiratory and circulatory support in critically ill patients. In our study, we report on a single center experience with ECMO and aim to identify the prognostic markers for survival to discharge from hospital. METHODS: A registry was maintained on all patients who underwent ECMO implantation from September 2012 till January 2016 at a single institution. The collected data was analyzed to identify baseline characteristics, outcomes including clinical variables predictive of poor outcome. RESULTS: A total of 29 patients underwent ECMO implantation. The average age of patients was 42±18years. 59% were males (N=17). 19 cases had a cardiac indication for ECMO (66%) while 10 cases had a pulmonary indication (34%). On univariate analysis; presence of Multi-organ failure, SOFA score more than 18 and hemoglobin less than 10g/dl at baseline and after ECMO removal were associated with increased 30day mortality. Pearson correlation with 30day mortality showed a positive correlation with MOF (+0.562, p=0.002) and SOFA score >18 (+0.448, p=0.015) and a negative correlation with anemia (-0.507, p=0.005). 15 out of the total 29 patients (52%) died within 30days of admission. Patients with MOF (log rank: 10.926, p=0.001), SOFA score >18 (log rank: 7.758, p=0.005) and hemoglobin <10g/dl (log rank: 5.595, p=0.018) had decreased survival on 30day follow up. CONCLUSIONS: Although the use of ECMO as a last line in the treatment of critical patients refractory to conventional treatment measures constitutes an important improvement in their care; with 48% overall survival; patient selection and timing of ECMO initiation remains challenging. Patients who already had signs of MOF and a high SOFA score portended a poor response. Similarly for anemic patients. Hence the importance of consideration for ECMO use earlier in course of illness rather than later. Screening and aggressive treatment of anemia in those patients may help improve the outcomes.
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Anemia/complicaciones , Oxigenación por Membrana Extracorpórea/métodos , Insuficiencia Multiorgánica/diagnóstico , Puntuaciones en la Disfunción de Órganos , Sistema de Registros , Síndrome de Dificultad Respiratoria/complicaciones , Choque Cardiogénico/cirugía , Adulto , Anemia/mortalidad , Femenino , Mortalidad Hospitalaria/tendencias , Humanos , Incidencia , Masculino , Insuficiencia Multiorgánica/epidemiología , Insuficiencia Multiorgánica/etiología , Síndrome de Dificultad Respiratoria/diagnóstico , Síndrome de Dificultad Respiratoria/mortalidad , Estudios Retrospectivos , Choque Cardiogénico/complicaciones , Choque Cardiogénico/mortalidad , Tasa de Supervivencia/tendencias , Resultado del Tratamiento , Emiratos Árabes Unidos/epidemiologíaRESUMEN
A 75-year-old woman with a history of atrial fibrillation, severe biatrial enlargement, persistent dense spontaneous echo contrast in the left atrium and left-atrial appendage on appropriate oral anticoagulant therapy underwent implantation of the left-atrial occlusion device to decrease her risk of thromboembolic stroke. Six weeks later, a scheduled transesophageal echocardiography showed a partially mobile mass (4.1 × 2.1 cm) overlying the atrial surface of the device: a suspected thrombus. This report highlights the importance of follow-up examination and the limitation of this treatment modality among patients with persistent atrial fibrillation, large left atria and dense spontaneous echo contrast.