The use of extracorporeal membrane oxygenation in the setting of postinfarction mechanical complications: outcome analysis of the Extracorporeal Life Support Organization Registry

OBJECTIVES:Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been recently considered and used for patients with post-acute myocardial infarction mechanical complications (post-AMI MC); however, information in this respect is scarce. The purpose of this study was to evaluate the in-hospital outcomes of patients with post-AMI MC submitted to VA-ECMO, and enrolled in the Extracorporeal Life Support Organizations (ELSO)'s data Registry.METHODS: This was a retrospective review of the ELSO Registry to identify adult (>18years old) patients with post-AMI MC who underwent VA-ECMO support between 2007 and 2018. The primary end point of this study was in-hospital survival. ECMO complications were also evaluated.RESULTS: The patient cohort available for this study included 158 patients. The median age was 62.4years (range 20-80). The most common post-AMI MC was ventricular septal rupture (n=102; 64.5%), followed by papillary muscle rupture (n=42; 26.6%) and ventricular free-wall rupture (n=14; 8.9%). Approximately a quarter of patients (n=41; 25.9%) had cardiac arrest before VA-ECMO institution. The median duration of VA-ECMO was 5.9days (range 1h-40.3days). ECMO complications occurred in 119 patients (75.3%). Overall, survival to hospital discharge for the entire patient cohort was 37.3%. Patients who had ventricular septal rupture as primary diagnosis had higher in-hospital mortality (n=66; 64.7%).CONCLUSIONS: In patients with post-AMI MC, VA-ECMO provides haemodynamic stabilizations and carries a potential to reverse otherwise lethal course. ECMO complications, however, remain an important limitation. Further investigations are required to better evaluate the efficacy and safety of ECMO in this context.