Analysis of factors influencing extracorporeal membrane oxygenation combined with intra-aortic balloon pump in the treatment of cardiac shock

doi:10.3969/j.issn.1004-583X.2025.11.002

Abstract

Abstract:

Objective To investigate the factors influencing the success of rescue using extracorporeal membrane oxygenation (ECMO) combined with an intra-aortic balloon pump (IABP) in patients with cardiogenic shock (CS). Methods A total of 40 CS patients who received veno-arterial extracorporeal membrane oxygenation (VA-ECMO) combined with IABP for cardiopulmonary support during rescue in the Cardiac Care Unit of Zhengzhou Central Hospital Affiliated to Zhengzhou University between December 2018 and December 2023 were selected. Based on rescue outcomes, patients were divided into the survival group (n=17) and the death group (n=23). Clinical data of both groups were collected and analyzed. Logistic regression analysis was used to explore the factors influencing the successful rescue. Results Patients in the survival group had significantly lower age, lactate levels, time to restoration of spontaneous rhythm, and alanine aminotransferase (ALT) levels on admission compared to the death group (P<0.05). The primary disease was resolved in 100% of patients in the survival group and 21.7% in the death group, showing a significant difference (P<0.05). No significant differences were found between the two groups in the proportion of malignant arrhythmias occurring during rescue and the worst left ventricular ejection fraction (LVEF) levels during hospitalization (P>0.05). Univariate logistic regression analysis showed that longer time to restore spontaneous rhythm, higher maximum lactic acid in blood gas analysis and older age predicted a higher risk of death(P<0.05,OR>1). The higher minimum standard residual base and higher minimum pH in blood gas analysis predicted a lower risk of death (P<0.05, OR<1). Conclusion When using ECMO combined with IABP to rescue CS patients, timely resolution of the primary disease may be key to successful rescue. Shortening the time to restore spontaneous rhythm and maintaining internal homeostasis may be important components of successful rescue.

Key words: shock, cardiogenic, extracorporeal membrane oxygenation, intra-aortic balloon pumping, rescue

CLC Number:

R542.22

Shi Huili, Wang Peipei, Ma Dongpu, Yang Yanpeng. Analysis of factors influencing extracorporeal membrane oxygenation combined with intra-aortic balloon pump in the treatment of cardiac shock[J]. Clinical Focus, 2025, 40(11): 973-977.

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URL: https://www.lchc.cn/EN/10.3969/j.issn.1004-583X.2025.11.002

https://www.lchc.cn/EN/Y2025/V40/I11/973

Figures/Tables 3

Tab.1 Comparison of clinical data between the two groups

项目	存活组( $n$ =17)	死亡组( $n$ =23)	统计值	$P$ 值
年龄(岁)	55.3±11.8	65.3±11.9	-2.647	0.012
女性[例(%)]	4(23.5)	8(34.8)	0.589	0.505
吸烟史[例(%)]	8(47.0)	12(52.2)	0.102	1.000
高血压病史[例(%)]	6(35.3)	12(52.2)	1.125	0.348
糖尿病史[例(%)]	4(23.5)	7(30.4)	0.234	0.730
冠心病史[例(%)]	4(23.5)	7(30.4)	0.234	0.730
脑卒中史[例(%)]	2(11.8)	7(30.4)	1.954	0.256
抢救时心肺复苏[例(%)]	13(76.5)	20(87.0)	0.744	0.432
出现恶性心律失常[例(%)]	14(82.4)	17(73.9)	0.399	0.707
解决原发病[例(%)]	17(100.0)	5(21.7)	24.190	0.000
血气分析中最低标准剩余碱	-11.2±4.3	-18.8±6.4	4.212	0.000
血气分析中最高乳酸(mmol/L)	11.06±4.4	17.04±6.9	-3.138	0.003
血气分析中最低pH	7.12±0.10	7.05±0.19	2.975	0.005
入院首次血糖(mmol/L)	13.56±5.51	12.69±7.02	0.420	0.677
恢复自主心律时间(min)	7.50(4.75, 20.50)	55.00(35.00,60.00)	-4.455	0.000
入院肌酐(μmol/L)	99.10(79.05, 12.4)	109.20(60.20, 142.40)	-0.150	0.892
入院ALT(U/L)	248.00(170.5, 427.5)	479.00(312.00, 2272.00)	-2.230	0.026
入院AST(U/L)	724.00(346.00, 1045.00)	925.00(925.00, 2823.00)	-1.272	0.203
住院期间最差LVEF(%)	30.00(26.00, 38.00)	30.00(25.00, 40.00)	-0.411	0.685

Tab.1 Comparison of clinical data between the two groups

项目	存活组( $n$ =17)	死亡组( $n$ =23)	统计值	$P$ 值
年龄(岁)	55.3±11.8	65.3±11.9	-2.647	0.012
女性[例(%)]	4(23.5)	8(34.8)	0.589	0.505
吸烟史[例(%)]	8(47.0)	12(52.2)	0.102	1.000
高血压病史[例(%)]	6(35.3)	12(52.2)	1.125	0.348
糖尿病史[例(%)]	4(23.5)	7(30.4)	0.234	0.730
冠心病史[例(%)]	4(23.5)	7(30.4)	0.234	0.730
脑卒中史[例(%)]	2(11.8)	7(30.4)	1.954	0.256
抢救时心肺复苏[例(%)]	13(76.5)	20(87.0)	0.744	0.432
出现恶性心律失常[例(%)]	14(82.4)	17(73.9)	0.399	0.707
解决原发病[例(%)]	17(100.0)	5(21.7)	24.190	0.000
血气分析中最低标准剩余碱	-11.2±4.3	-18.8±6.4	4.212	0.000
血气分析中最高乳酸(mmol/L)	11.06±4.4	17.04±6.9	-3.138	0.003
血气分析中最低pH	7.12±0.10	7.05±0.19	2.975	0.005
入院首次血糖(mmol/L)	13.56±5.51	12.69±7.02	0.420	0.677
恢复自主心律时间(min)	7.50(4.75, 20.50)	55.00(35.00,60.00)	-4.455	0.000
入院肌酐(μmol/L)	99.10(79.05, 12.4)	109.20(60.20, 142.40)	-0.150	0.892
入院ALT(U/L)	248.00(170.5, 427.5)	479.00(312.00, 2272.00)	-2.230	0.026
入院AST(U/L)	724.00(346.00, 1045.00)	925.00(925.00, 2823.00)	-1.272	0.203
住院期间最差LVEF(%)	30.00(26.00, 38.00)	30.00(25.00, 40.00)	-0.411	0.685

Tab.2 Assignment of independent variables and dependent variables in the univariate logistic regression analysis

变量	赋值
因变量(Y)
是否死亡	否=0,是=1
自变量(X)
年龄	连续变量
血气分析中最低标准剩余碱	连续变量
血气分析中最低pH	连续变量
血气分析中最高乳酸	连续变量
入院首次血糖	连续变量
恢复自主心律时间	连续变量
入院肌酐	连续变量
入院ALT	连续变量
入院AST	连续变量
住院期间最差LVEF	连续变量
性别	女性=0,男性=1
吸烟史	是=1,否=0
高血压病史	是=1,否=0
糖尿病史	是=1,否=0
冠心病史	是=1,否=0
脑卒中史	是=1,否=0
抢救时心肺复苏	是=1,否=0
出现恶性心律失常	是=1,否=0
解决原发病	是=1,否=0

Tab.3 Univariate logistic regression analysis of the influencing factors on the success of ECMO combined with IABP in rescuing CS patients

危险因素	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	95%可信区间
危险因素	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	下限	上限
年龄	0.074	0.032	5.244	0.022	1.076	1.011	1.147
血气分析中最低标准剩余碱	-0.259	0.085	9.252	0.002	0.772	0.653	0.912
血气分析中最高乳酸	0.182	0.070	6.814	0.009	1.200	1.047	1.376
血气分析中最低pH	-5.899	2.502	5.556	0.018	0.003	0.000	0.370
恢复自主心律时间	0.188	0.072	6.834	0.009	1.207	1.048	1.389

Tab.3 Univariate logistic regression analysis of the influencing factors on the success of ECMO combined with IABP in rescuing CS patients

危险因素	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	95%可信区间
危险因素	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	下限	上限
年龄	0.074	0.032	5.244	0.022	1.076	1.011	1.147
血气分析中最低标准剩余碱	-0.259	0.085	9.252	0.002	0.772	0.653	0.912
血气分析中最高乳酸	0.182	0.070	6.814	0.009	1.200	1.047	1.376
血气分析中最低pH	-5.899	2.502	5.556	0.018	0.003	0.000	0.370
恢复自主心律时间	0.188	0.072	6.834	0.009	1.207	1.048	1.389

References 21

[1]	Sinha SS, Morrow DA, Kapur NK, et al. 2025 concise clinical guidance: An ACC expert consensus statement on the evaluation and management of cardiogenic shock: A report of the American College of Cardiology Solution Set Oversight Committee[J]. J Am Coll Cardiol, 2025, 85(16):1618-1641. doi: 10.1016/j.jacc.2025.02.018.
[2]	中华医学会心血管病学分会, 中华心血管病杂志编辑委员会. 经皮机械循环辅助在复杂心血管疾病介入治疗应用中国专家共识[J]. 中华心血管病杂志, 2022, 50(10):959-972.doi:10.3760/cma.j.cn112148-20220104-00004.
[3]	Gu J, Hu W, Xiao H, et al. Intra-aortic balloon pump improves clinical prognosis and attenuates C-reactive protein level in acute STEMI complicated by cardiogenic shock[J]. Cardiology, 2010, 117(1):75-80. doi: 10.1159/000319618. pmid: 20924182
[4]	Takayama H, Truby L, Koekort M, et al. Clinical outcome of mechanical circulatory support for refractory cardiogenic shock in the current era[J]. J Heart Lung Transplant, 2013, 32(1):106-111. doi: 10.1016/j.healun.2012.10.005.
[5]	Gandhi KD, Moras EC, Niroula S, et al. Left ventricular unloading with impella versus IABP in patients with VA-ECMO: A systematic review and meta-analysis[J]. Am J Cardiol, 2023, 208:53-59. doi: 10.1016/j.amjcard.2023.09.023. pmid: 37812867
[6]	Zeng P, Yang C, Chen J, et al. Comparison of the efficacy of ECMO with or without IABP in patients with cardiogenic shock: A meta-analysis[J]. Front Cardiovasc Med, 2022, 9:917610. doi: 10.3389/fcvm.2022.917610.
[7]	中国心胸血管麻醉学会, 中华医学会麻醉学分会, 中国医师协会麻醉学医师分会, 等. 不同情况下成人体外膜肺氧合临床应用专家共识(2020版)[J]. 中国循环杂志, 2020, 35(11):1052-1063.doi:10.3969/j.issn.1000-3614.2020.11.002.
[8]	国家心血管病中心, 国家心血管病专家委员会心力衰竭专业委员会, 中国医师协会心力衰竭专业委员会, 等. 国家心力衰竭指南2023[J]. 中华心力衰竭和心肌病杂志, 2023, 7(4):215-311.doi:10.3760/cma.j.issn.101460-20231209-00052.
[9]	Laslett LJ, Alagona P Jr, Clark BA 3rd, et al. The worldwide environment of cardiovascular disease: Prevalence, diagnosis, therapy, and policy issues: A report from the American College of Cardiology[J]. J Am Coll Cardiol, 2012, 60(25 Suppl):S1-49. doi: 10.1016/j.jacc.2012.11.002.
[10]	Waksman R, Pahuja M, van Diepen S, et al. Standardized definitions for cardiogenic shock research and mechanical circulatory support devices: Scientific expert panel from the Shock Academic Research Consortium (SHARC)[J]. Circulation, 2023, 148:1113-1126.doi: 10.1161/CIRCULATIONAHA.123.064527. pmid: 37782695
[11]	潘晨亮, 赵晶, 胡思雄, 等. 急性心肌梗死合并心源性休克患者应用VA-ECMO联合IABP的时机探索[J]. 中华心血管病杂志, 2023, 51(8):851-858. doi:10.3760/cma.j.cn112148-20230706-00396.
[12]	Marashly Q, Taleb I, Kyriakopoulos CP, et al. Predicting mortality in cardiogenic shock secondary to ACS requiring short-term mechanical circulatory support: The ACS-MCS score[J]. Catheter Cardiovasc Interv, 2021, 98(7):1275-1284. doi: 10.1002/ccd.29581.
[13]	芮子傲, 戴东普, 郭影影, 等. 主动脉内球囊反搏联合体外膜肺氧合对于急性心肌梗死合并心源性休克患者的疗效及相关影响因素分析[J]. 中国全科医学, 2022, 25(21):2597-2604.doi:10.12114/j.issn.1007-9572.2022.0108.
[14]	Shirakabe A, Matsushita M, Shibata Y, et al. Organ dysfunction, injury, and failure in cardiogenic shock[J]. J Intensive Care, 2023, 11(1):26. doi:10.1186/s40560-023-00676-1. pmid: 37386552
[15]	Jäntti T, Tarvasmäki T, Harjola VP, et al. Frequency and prognostic significance of abnormal liver function tests in patients with cardiogenic shock[J]. Am J Cardiol, 2017, 120(7):1090-1097. doi:10.1016/j.amjcard.2017.06.049. pmid: 28821350
[16]	Narang N, Dela Cruz M, Imamura T, et al. Discordance between lactic acidemia and hemodynamics in patients with advanced heart failure[J]. Clin Cardiol, 2021, 44(5):636-645. doi: 10.1002/clc.23584. pmid: 33734459
[17]	Kraut JA, Madias NE. Treatment of acute metabolic acidosis: A pathophysiologic approach[J]. Nat Rev Nephrol, 2012, 8(10):589-601. doi: 10.1038/nrneph.2012.186. pmid: 22945490
[18]	Jentzer JC, Tabi M, Burstein B. Managing the first 120min of cardiogenic shock: From resuscitation to diagnosis[J]. Curr Opin Crit Care, 2021, 27(4):416-425. doi: 10.1097/MCC.0000000000000839. pmid: 33967208
[19]	王欢, 郑家伟, 彭登高. 心脏骤停患者心肺复苏后自主循环恢复和生存的影响因素分析[J]. 岭南急诊医学杂志, 2024, 29(2):82-85.doi:10.3969/j.issn.1671-301X.2024.02.002.
[20]	中华医学会心血管病学分会, 中国生物医学工程学会心律分会. 抗心律失常药物临床应用中国专家共识[J]. 中华心血管病杂志, 2023, 51(3):256-269.doi:10.3760/cma.j.cn112148-20230130-00047.
[21]	Kloner RA. Stunned and hibernating myocardium: Where are we nearly 4 decades later?[J] J Am Heart Assoc, 2020, 9(3):e015502.doi: 10.1161/JAHA.119.015502.