潘晨亮,赵晶,张博,卢安东,白明

• 1:兰州大学第一医院心脏中心甘肃省心血管疾病重点实验室甘肃省心血管病临床医学研究中心

摘要(Abstract)：

目的 总结分析应用体外膜肺氧合（ECMO）救治急性心肌梗死合并心搏骤停患者的临床特点及预后。方法 回顾性纳入2020年1月至2022年2月兰州大学第一医院心脏中心应用ECMO联合心肺复苏（CPR）救治急性心肌梗死合并有目击的心搏骤停患者22例，按照院内结局分为存活组6例和死亡组16例，比较两组患者临床情况。结果 所有患者平均年龄（62.1±10.0）岁，其中女2例（2/22），死亡组患者心搏骤停前出现心原性休克的比例高于存活组（P=0.046）；所有患者中有11例（11/22）患者的罪犯血管为左前降支，有11例（11/22）患者的罪犯血管术前心肌梗死溶栓治疗试验（TIMI）血流分级0级，有11例（11/22）患者的冠状动脉病变≥2支，有5例（5/22）患者合并冠状动脉慢性闭塞，中位支架置入数目1.0(1.0,2.0)枚；神经元特异性烯醇化酶在存活组明显低于死亡组[33.4(24.8,38.8)mmol/L比80.8(58.7,240.0)mmol/L,P=0.012]；存活出院的6例患者中，其中格拉斯哥-匹兹堡脑功能表现分级（CPC）1～2级患者有5例（5/6）,CPC3～5级患者有1例（1/6）;30 d内6例患者均存活。结论 ECMO联合CPR联合急诊经皮冠状动脉介入治疗，可作为胸痛中心流程中对急性心肌梗死合并心搏骤停患者救治的有效策略，可能改善患者的预后，对此类患者神经功能损伤的恢复需要重点关注。

关键词(KeyWords)： 急性心肌梗死;心搏骤停;心肺复苏;体外膜肺氧合

Abstract:

Keywords:

基金项目(Foundation): 甘肃省科技重点研发计划项目（21YF5FA118）;; 甘肃省青年科技基金计划项目（21JR7RA385）

作者(Author): 潘晨亮,赵晶,张博,卢安东,白明

参考文献(References)：

• [1] Subramaniam AV, Patlolla SH, Cheungpasitporn W, et al. Racial and ethnic disparities in management and outcomes of cardiac arrest complicating acute myocardial infarction[J]. J Am Heart Assoc, 2021, 10(11):e019907.
• [2] Henry TD, Tomey MI, Tamis-Holland JE, et al. Invasive management of acute myocardial infarction complicated by cardiogenic shock:a scientific statement from the American Heart Association[J]. Circulation, 2021, 143(15):e815-e829.
• [3] Guglin M, Zucker MJ, Bazan VM, et al. Venoarterial ECMO for adults:JACC scientific expert panel[J]. J Am Coll Cardiol, 2019, 73(6):698-716.
• [4] Lorusso R, Shekar K, MacLaren G, et al. AHA interim guidelines for venoarterial extracorporeal membrane oxygenation in adult cardiac patients[J]. ASAIO J, 2021, 67(8):827-844.
• [5]中国医师协会体外生命支持专业委员会.成人体外膜氧合循环辅助专家共识[J].中华医学杂志，2018,98(12):886-894.
• [6]刘迎午，李彤，王赟赟，等.体外膜肺氧合辅助下危重急性心肌梗死紧急介入治疗的临床疗效分析[J].中国介入心脏病学杂志，2015,23(12):689-692.
• [7] Thygesen K, Alpert JS, Jaffe AS, et al. Fourth universal definition of myocardial infarction(2018)[J]. Circulation,2018, 138(20):e618-e651.
• [8] Chan PS, McNally B, Tang F, et al. Recent trends in survival from out-of-hospital cardiac arrest in the United States[J].Circulation, 2014, 130(21):1876-1882.
• [9] Girotra S, Nallamothu BK, Spertus JA, et al. Trends in survival after in-hospital cardiac arrest[J]. N Engl J Med,2012, 367(20):1912-1920.
• [10] Andersen LW, Holmberg MJ, Berg KM, et al. In-hospital cardiac arrest:a review[J]. JAMA, 2019, 321(12):1200-1210.
• [11] Schmidt M, Burrell A, Roberts L, et al. Predicting survival after ECMO for refractory cardiogenic shock:the survival after veno-arterial-ECMO(SAVE)-score[J]. Eur Heart J,2015, 36(33):2246-2256.
• [12] Wang GN, Chen XF, Qiao L, et al. Comparison of extracorporeal and conventional cardiopulmonary resuscitation:a meta-analysis of 2 260 patients with cardiac arrest[J]. World J Emerg Med, 2017, 8(1):5-11.
• [13] Magid DJ, Aziz K, Cheng A, et al. Part 2:evidence evaluation and guidelines development:2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care[J]. Circulation, 2020, 142(16_suppl_2):S358-S365.
• [14] Yannopoulos D, Bartos JA, Raveendran G, et al. Coronary artery disease in patients with out-of-hospital refractory ventricular fibrillation cardiac arrest[J]. J Am Coll Cardiol, 2017, 70(9):1109-1117.
• [15] Ameloot K, Jakkula P, Hastbacka J, et al. Optimum blood pressure in patients with shock after acute myocardial infarction and cardiac arrest[J].J Am Coll Cardiol, 2020, 76(7):812-824.
• [16] Drummond JC. Blood pressure and the brain:how low can you go[J]? Anesth Analg, 2019, 128(4):759-771.
• [17] Lascarrou JB, Merdji H, Le Gouge A, et al. Targeted temperature management for cardiac arrest with nonshockable rhythm[J]. N Engl J Med, 2019, 381(24):2327-2337.
• [18] Oddo M, Crippa IA, Mehta S, et al. Optimizing sedation in patients with acute brain injury[J]. Critical care(London,England), 2016, 20(1):128.
• [19] Robba C, Poole D, McNett M, et al. Mechanical ventilation in patients with acute brain injury:recommendations of the European Society of Intensive Care Medicine consensus[J].Intensive Care Med, 2020, 46(12):2397-2410.
• [20] Sandroni C, Cariou A, Cavallaro F, et al. Prognostication in comatose survivors of cardiac arrest:an advisory statement from the European Resuscitation Council and the European Society of Intensive Care Medicine[J]. Resuscitation, 2014, 85(12):1779-1789.
• [21] Freeman CL, Bennett TD, Casper TC, et al. Pediatric and neonatal extracorporeal membrane oxygenation:does center volume impact mortality[J]? Crit Care Med, 2014, 42(3):512-519.
• [22] Weinberg A, Miko B, Beck J, et al. Is it safe to leave an ECMO circuit primed[J]? Perfusion, 2015, 30(1):47-49.