Same-Day Versus Non-Simultaneous Extracorporeal Membrane Oxygenation Support for In-Hospital Cardiac Arrest Complicating Acute Myocardial Infarction

• Authors: Saraschandra Vallabhajosyula, Mayo Clinic; Sri Harsha Patlolla, Mayo Clinic; Malcolm R. Bell, Mayo Clinic; Wisit Cheungpasitporn, University of Mississippi; John M. Stulak, Mayo Clinic; Gregory J. Schears, Mayo Clinic; Gregory W. Barsness, Mayo Clinic; David R. Holmes, Mayo Clinic
• Journal Title: Journal of Clinical Medicine
• Volume: Volume 9, Number 8
• Publisher: MDPI AG | 2020-08-12
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.3390/jcm9082613
• Subjects: Health Sciences, Health Care Management; Health Sciences, Medicine and Surgery; Health Sciences, Public Health
• Keywords: acute myocardial infarction; extracorporeal membrane oxygenation; in-hospital cardiac arrest; eCPR

Abstract

Background: Although extracorporeal membrane oxygenation (ECMO) is used for hemodynamic support for in-hospital cardiac arrest (IHCA) complicating acute myocardial infarction (AMI), there are limited data on the outcomes stratified by the timing of initiation of this strategy. Methods: \Adult (>18 years) AMI admissions with IHCA were identified using the National Inpatient Sample (2000–2017) and the timing of ECMO with relation to IHCA was identified. Same-day vs. non-simultaneous ECMO support for IHCA were compared. Outcomes of interest included in-hospital mortality, temporal trends, hospitalization costs, and length of stay. Results: Of the 11.6 million AMI admissions, IHCA was noted in 1.5% with 914 (<0.01%) receiving ECMO support. The cohort receiving same-day ECMO (N = 795) was on average female, with lower comorbidity, higher rates of ST-segment-elevation AMI, shockable rhythm, and higher rates of complications. Compared to non-simultaneous ECMO, the same-day ECMO cohort had higher rates of coronary angiography (67.5% vs. 51.3%; p = 0.001) and comparable rates of percutaneous coronary intervention (58.9% vs. 63.9%; p = 0.32). The same-day ECMO cohort had higher in-hospital mortality (63.1% vs. 44.5%; adjusted odds ratio 3.98 (95% confidence interval 2.34–6.77); p < 0.001), shorter length of stay, and lower hospitalization costs. Older age, minority race, non-ST-segment elevation AMI, multiorgan failure, and complications independently predicted higher in-hospital mortality in IHCA complicating AMI. Conclusions: Same-day ECMO support for IHCA was associated with higher in-hospital mortality compared to those receiving non-simultaneous ECMO support. Though ECMO-assisted CPR is being increasingly used, careful candidate selection is key to improving outcomes in this population.