Mechanical circulatory support (MCS) devices, especially veno-arterial extracorporeal membrane oxygenation (VA-ECMO) devices, are increasingly used to shore complex cardiac procedures in high-risk patients. We are reporting two cases where patients underwent coronary artery bypass grafting (CABG) under support of VA-ECMO in the setting of cardiogenic shock complicating acute myocardial infarction. The patients had different courses, but both survived the initial insult and were weaned successively from VA-ECMO. Our report indicates that VA-ECMO can be used instead of the cardiopulmonary bypass machine (CPB) to support the circulation during CABG surgery in patients with complex coronary anatomy and unstable haemodynamics. Future studies focusing on the long-term outcomes of such patients will probably help to establish the optimal management of this type of patients.
StretchRSauerCMYuhDD, et al. National trends in the utilization of short-term mechanical circulatory support: incidence, outcomes, and cost analysis. J Am Coll Cardiol2014; 64: 1407–1415.
2.
CavarocchiNC.Introduction to extracorporeal membrane oxygenation.Crit Care Clin2017; 33: 763–766.
3.
KeeblerMEHaddadEVChoiCW, et al. Venoarterial extracorporeal membrane oxygenation in cardiogenic shock. JACC Heart Fail2018; 6: 503–516.
4.
MakdisiGMakdisiPBWangIW.Use of extracorporeal membranous oxygenator in transcatheter aortic valve replacement. Ann Transl Med2016; 4: 306.
5.
HuangCCHsuJCWuYW, et al. Implementation of extracorporeal membrane oxygenation before primary percutaneous coronary intervention may improve the survival of patients with ST-segment elevation myocardial infarction and refractory cardiogenic shock. Int J Cardiol2018; 269: 45–50.
6.
BiancariFDalénMPerrottiA, et al. Venoarterial extracorporeal membrane oxygenation after coronary artery bypass grafting: results of a multicenter study. Intl J Cardiol2017; 241: 109–114.
7.
van DiepenSKatzJNAlbertNM, et al. Contemporary management of cardiogenic shock: a scientific statement from the American Heart Association. Circulation2017; 136: e232–e268.
8.
MehtaRHGrabJDO’BrienSM, et al. Clinical characteristics and in-hospital outcomes of patients with cardiogenic shock undergoing coronary artery bypass surgery: insights from the Society of Thoracic Surgeons National Cardiac Database. Circulation2008; 117: 876–885.
9.
NappLCKühnCBauersachsJ.ECMO in cardiac arrest and cardiogenic shock. Herz2017; 42: 27–44.
LeickJLiebetrauCSzardienS, et al. Door-to-implantation time of extracorporeal life support systems predicts mortality in patients with out-of-hospital cardiac arrest. Clin Res Cardiol2013; 102: 661–669.
12.
BiancariFPerrottiADalénM, et al. Meta-analysis of the outcome after postcardiotomy venoarterial extracorporeal membrane oxygenation in adult patients. J Cardiothorac Vasc Anesth2018; 32: 1175–1182.
13.
DebatyGBabazVDurandM, et al. Prognostic factors for extracorporeal cardiopulmonary resuscitation recipients following out-of-hospital refractory cardiac arrest. A systematic review and meta-analysis. Resuscitation2017; 112: 1-10.
14.
FuxTHolmMCorbascioM, et al. Venoarterial extracorporeal membrane oxygenation for postcardiotomy shock: risk factors for mortality. J Thorac Cardiovasc Surg2018; 156: 1894–1902.e3.
15.
MunganİKazancıDBektaşŞ, et al. Does lactate clearance prognosticates outcomes in ECMO therapy: a retrospective observational study. BMC Anesthesiol2018; 18: 152.
16.
WangLYangFWangX, et al. Predicting mortality in patients undergoing VA-ECMO after coronary artery bypass grafting: the REMEMBER score. Crit Care2019; 23: 11.
17.
HillisLDSmithPKAndersonJL, et al. 2011 ACCF/AHA guideline for coronary artery bypass graft surgery. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Developed in collaboration with the American Association for Thoracic Surgery, Society of Cardiovascular Anesthesiologists, and Society of Thoracic Surgeons. J Am CollCardiol2011; 58: e123–e210.
18.
WuMYTsengYHChangYS, et al. Using extracorporeal membrane oxygenation to rescue acute myocardial infarction with cardiopulmonary collapse: the impact of early coronary revascularization. Resuscitation2013; 84: 940–945.
19.
ThieleHZeymerUThelemannN, et al. Intraaortic balloon pump in cardiogenic shock complicating acute myocardial infarction: long-term 6-year outcome of the randomized IABP-SHOCK II trial. Circulation2019; 139: 395–403.
ChamogeorgakisTLimaBShafiiAE, et al. Outcomes of axillary artery side graft cannulation for extracorporeal membrane oxygenation. J Thorac Cardiovasc Surg2013; 145: 1088–1092.
22.
ChengRHachamovitchRKittlesonM, et al. Complications of extracorporeal membrane oxygenation for treatment of cardiogenic shock and cardiac arrest: a meta-analysis of 1,866 adult patients. Ann Thorac Surg2014; 97: 610–616.
