Dr. Michael Mooney talks about his 2013 ACC presentation (link to video below)
The use of extracorporeal membrane oxygenation (ECMO), accompanied by mechanical CPR, in patients with massive myocardial infarctions can lead to unexpected survival. These study findings are being presented March 9 at the American College of Cardiology Scientific Sessions.
ECMO is an advanced technology that functions as a replacement for a
critically ill patient's heart and lungs. This is the first report of
combined ECMO, mechanical CPR and therapeutic hypothermia (TH) use
within a STEMI Network.
"For many patients who present with a severe heart attack, or
ST-elevation myocardial infarction (STEMI), complicated by cardiogenic
shock that progresses to cardiac standstill, the result is almost
uniformly fatal," says Michael R. Mooney, MD, a research cardiologist at
the Minneapolis Heart Institute Foundation (MHIF) and a physician at
the Minneapolis Heart Institute® at Abbott Northwestern Hospital in
Minneapolis. "This aggressive approach despite its complexity extends
our ability to salvage the most devastating complication of acute MI."
The patients in this study were a consecutive series with STEMI
meeting criteria for ECMO from August 2011 to October 2012. The Shock
Team comprised of a perfusionist, an advanced heart failure
cardiologist, an interventional cardiologist and a cardiac surgeon
developed a protocol and a process for emergency ECMO (E-ECMO) in the CV
lab. This same team was then used to implement E-ECMO.
The study included five patients (three males) with a median age of
64 years. The median time of cardiac arrest from the initiation of ECMO
was 52 minutes, and ECMO was required for a median time of 4 days in
these patients. After ECMO was initiated, therapeutic hypothermia was
used in 4 of the cases. Mechanical CPR devices were used in all cases.
Of the five patients, four survived to hospital discharge and all of
the survivors had "good neurologic recovery at discharge," Mooney
reports. Of the four survivors, discharge ejection fraction improved
from 0-10% to a median of 45%. Blood transfusions were required in all
This group of patients account for nearly half of all deaths within a
STEMI network and no effective treatment was previously available.
"ECMO, along with mechanical CPR, and TH can provide survival in
situations previously regarded as uniformly fatal. Therefore, ECMO may
have a role in selected PCI centers with advanced specialized teams with
the appropriate experience," stated Mooney.