The major adverse kidney events in acute myocardial infarction with extracorporeal cardiopulmonary resuscitation
Objective To investigate the major adverse kidney events(MAKE)in acute myocardial infarction(AMI)with extracorporeal cardiopulmonary resuscitation(ECPR).Methods The data of 75 patients with AMI-ECPR in Emergency Medicine Department of the First Affiliated Hospital of Nanjing Medical University from April 2015 to April 2023 were retrospectively analyzed.The patients were grouped by survival/death at 90 days,with/without renal replacement therapy(RRT),and whether to initiate RRT because of acute kidney injury(AKI).age,sex,Charlson comorbidity index,OHCA/IHCA(out-of-hospital/in-hospital cardiac arrest),initial rhythm,Gensini score,ECPR initial blood gas pH and lactate value,no-flow time,time from cardiac arrest to extracorporeal membrane oxygenation(ECMO)initiation(CA-Pump On time),ECMO and RRT treatment time,90-day survival rate were analyzed.Moreover,the renal function of the survivors was followed up.Results ① Total of 68 AMI-ECPR patients were enrolled,22(32.4％)patients survived at 90 days,54(79.4％)combined with RRT,and 48(70.6％)MAKE within 90 days.② Compared with the death group,the 90-day survival group had a higher proportion of initial shockable heart rhythm,a lower Gensini score,a higher ECPR initial blood gas pH and a lower lactic acid value.③ The severity of coronary artery disease,ECPR initial acidosis and hyperlactacemia in the RRT group was significantly higher than that in the non-RRT group,and all the non-RRT group patients survived.④ There was no difference between the AKI-RRT group and the non-AKI-RRT group.Of 21 patients with stage 1 AKI initiating RRT,5 survived,one of them still needs RRT for 90 days,and 7 patients with stage 2 to 3 AKI initiating RRT died.Conclusions The 90-day MAKE rate in AMI-ECPR patients was as high as 70.6％,and the 90-day renal insufficiency rate in AMI-ECPR survivors with AKI was as high as 20.0％.Active initiation of RRT to avoid AKI or early initiation of RRT may improve the prognosis of AMI-ECPR patients.
万方数据
维普
