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Multidisciplinary team approach in acute myocardial infarction patients undergoing veno-arterial extracorporeal membrane oxygenation

BACKGROUND: Limited data are available on the impact of a specialized extracorporeal membrane oxygenation (ECMO) team on clinical outcomes in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS). This study evaluated whether specialized ECMO team is associated with i...

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Autores principales: Hong, David, Choi, Ki Hong, Cho, Yang Hyun, Cho, Su Hyun, Park, So Jin, Kim, Darae, Park, Taek Kyu, Lee, Joo Myung, Song, Young Bin, Choi, Jin-Oh, Hahn, Joo-Yong, Choi, Seung-Hyuk, Choi, Jin-Ho, Sung, Kiick, Gwon, Hyeon-Cheol, Jeon, Eun-Seok, Yang, Jeong Hoon
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7296889/
https://www.ncbi.nlm.nih.gov/pubmed/32548658
http://dx.doi.org/10.1186/s13613-020-00701-8
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author Hong, David
Choi, Ki Hong
Cho, Yang Hyun
Cho, Su Hyun
Park, So Jin
Kim, Darae
Park, Taek Kyu
Lee, Joo Myung
Song, Young Bin
Choi, Jin-Oh
Hahn, Joo-Yong
Choi, Seung-Hyuk
Choi, Jin-Ho
Sung, Kiick
Gwon, Hyeon-Cheol
Jeon, Eun-Seok
Yang, Jeong Hoon
author_facet Hong, David
Choi, Ki Hong
Cho, Yang Hyun
Cho, Su Hyun
Park, So Jin
Kim, Darae
Park, Taek Kyu
Lee, Joo Myung
Song, Young Bin
Choi, Jin-Oh
Hahn, Joo-Yong
Choi, Seung-Hyuk
Choi, Jin-Ho
Sung, Kiick
Gwon, Hyeon-Cheol
Jeon, Eun-Seok
Yang, Jeong Hoon
author_sort Hong, David
collection PubMed
description BACKGROUND: Limited data are available on the impact of a specialized extracorporeal membrane oxygenation (ECMO) team on clinical outcomes in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS). This study evaluated whether specialized ECMO team is associated with improved in-hospital mortality in AMI patients undergoing veno-arterial (VA) ECMO. METHODS: A total of 255 AMI patients who underwent VA-ECMO were included. In January 2014, a multidisciplinary ECMO team was founded at our institution. Eligible patients were classified into a pre-ECMO team group (n = 131) and a post-ECMO team group (n = 124). The primary outcome was in-hospital mortality. RESULTS: In-hospital mortality (pre-ECMO team vs. post-ECMO team, 54.2% vs. 33.9%; p = 0.002) and cardiac intensive care unit mortality (pre-ECMO team vs. post-ECMO team, 51.9% vs. 30.6%; p = 0.001) were significantly lower after the implementation of a multidisciplinary ECMO team. On multivariable logistic regression model, implementation of the multidisciplinary ECMO team was associated with reduction of in-hospital mortality [odds ratio: 0.37, 95% confidence interval (CI) 0.20–0.67; p = 0.001]. Incidence of all-cause mortality [58.3% vs. 35.2%; hazard ratio (HR): 0.49, 95% CI 0.34–0.72; p < 0.001) and readmission due to heart failure (28.2% vs. 6.4%; HR: 0.21, 95% CI 0.08–0.58; p = 0.003) at 6 months of follow-up were also significantly lower in the post-ECMO team group than in the pre-ECMO team group. CONCLUSIONS: Implementation of a multidisciplinary ECMO team was associated with improved clinical outcomes in AMI patients complicated by CS. Our data support that a specialized ECMO team is indispensable for improving outcomes in patients with AMI complicated by CS.
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spelling pubmed-72968892020-06-16 Multidisciplinary team approach in acute myocardial infarction patients undergoing veno-arterial extracorporeal membrane oxygenation Hong, David Choi, Ki Hong Cho, Yang Hyun Cho, Su Hyun Park, So Jin Kim, Darae Park, Taek Kyu Lee, Joo Myung Song, Young Bin Choi, Jin-Oh Hahn, Joo-Yong Choi, Seung-Hyuk Choi, Jin-Ho Sung, Kiick Gwon, Hyeon-Cheol Jeon, Eun-Seok Yang, Jeong Hoon Ann Intensive Care Research BACKGROUND: Limited data are available on the impact of a specialized extracorporeal membrane oxygenation (ECMO) team on clinical outcomes in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS). This study evaluated whether specialized ECMO team is associated with improved in-hospital mortality in AMI patients undergoing veno-arterial (VA) ECMO. METHODS: A total of 255 AMI patients who underwent VA-ECMO were included. In January 2014, a multidisciplinary ECMO team was founded at our institution. Eligible patients were classified into a pre-ECMO team group (n = 131) and a post-ECMO team group (n = 124). The primary outcome was in-hospital mortality. RESULTS: In-hospital mortality (pre-ECMO team vs. post-ECMO team, 54.2% vs. 33.9%; p = 0.002) and cardiac intensive care unit mortality (pre-ECMO team vs. post-ECMO team, 51.9% vs. 30.6%; p = 0.001) were significantly lower after the implementation of a multidisciplinary ECMO team. On multivariable logistic regression model, implementation of the multidisciplinary ECMO team was associated with reduction of in-hospital mortality [odds ratio: 0.37, 95% confidence interval (CI) 0.20–0.67; p = 0.001]. Incidence of all-cause mortality [58.3% vs. 35.2%; hazard ratio (HR): 0.49, 95% CI 0.34–0.72; p < 0.001) and readmission due to heart failure (28.2% vs. 6.4%; HR: 0.21, 95% CI 0.08–0.58; p = 0.003) at 6 months of follow-up were also significantly lower in the post-ECMO team group than in the pre-ECMO team group. CONCLUSIONS: Implementation of a multidisciplinary ECMO team was associated with improved clinical outcomes in AMI patients complicated by CS. Our data support that a specialized ECMO team is indispensable for improving outcomes in patients with AMI complicated by CS. Springer International Publishing 2020-06-16 /pmc/articles/PMC7296889/ /pubmed/32548658 http://dx.doi.org/10.1186/s13613-020-00701-8 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
spellingShingle Research
Hong, David
Choi, Ki Hong
Cho, Yang Hyun
Cho, Su Hyun
Park, So Jin
Kim, Darae
Park, Taek Kyu
Lee, Joo Myung
Song, Young Bin
Choi, Jin-Oh
Hahn, Joo-Yong
Choi, Seung-Hyuk
Choi, Jin-Ho
Sung, Kiick
Gwon, Hyeon-Cheol
Jeon, Eun-Seok
Yang, Jeong Hoon
Multidisciplinary team approach in acute myocardial infarction patients undergoing veno-arterial extracorporeal membrane oxygenation
title Multidisciplinary team approach in acute myocardial infarction patients undergoing veno-arterial extracorporeal membrane oxygenation
title_full Multidisciplinary team approach in acute myocardial infarction patients undergoing veno-arterial extracorporeal membrane oxygenation
title_fullStr Multidisciplinary team approach in acute myocardial infarction patients undergoing veno-arterial extracorporeal membrane oxygenation
title_full_unstemmed Multidisciplinary team approach in acute myocardial infarction patients undergoing veno-arterial extracorporeal membrane oxygenation
title_short Multidisciplinary team approach in acute myocardial infarction patients undergoing veno-arterial extracorporeal membrane oxygenation
title_sort multidisciplinary team approach in acute myocardial infarction patients undergoing veno-arterial extracorporeal membrane oxygenation
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7296889/
https://www.ncbi.nlm.nih.gov/pubmed/32548658
http://dx.doi.org/10.1186/s13613-020-00701-8
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