VA-ECMO SỚM NHƯ MỘT PHƯƠNG PHÁP HỖ TRỢ PHỤC HỒI TRONG NHỒI MÁU CƠ TIM CẤP BIẾN CHỨNG NGỪNG TUẦN HOÀN VÀ SỐC TIM BÁO CÁO CA LÂM SÀNG

Abstract

Introduction: Cardiac arrest and cardiogenic shock are particularly severe complications of acute myocardial infarction. Although advances in reperfusion strategies have substantially improved clinical outcomes, mortality in this patient population remains approximately 40-50%. In this context, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has increasingly been considered a promising mechanical circulatory support strategy, providing temporary hemodynamic stabilization, maintaining end-organ perfusion, and facilitating definitive treatment of the underlying cause. We report a case of acute myocardial infarction complicated by ventricular fibrillation, cardiac arrest, and severe cardiogenic shock, in which early VA-ECMO was instituted and served as a bridge to recovery, contributing to a favorable clinical outcome.

Case report: A 73-year-old male patient with a history of poorly controlled hypertension was admitted with acute chest pain and sudden cardiac arrest due to ventricular fibrillation. Return of spontaneous circulation was achieved after 3 minutes of advanced cardiopulmonary resuscitation. Hemodynamics remained dependent on two high-dose vasopressors. Coronary angiography revealed complete occlusion of the proximal left anterior descending artery, 90-95% stenosis of the left circumflex artery, and chronic total occlusion of the right coronary artery. According to the Society for Cardiovascular Angiography and Interventions shock classification, the patient was classified as SCAI stage D–E cardiogenic shock. Early VA-ECMO was established in combination with timely percutaneous coronary intervention, followed by hemodynamic recovery, successful weaning from VA-ECMO, and discharge without neurological sequelae.

Discussion: VA-ECMO may serve as a bridge to recovery in carefully selected patients with acute myocardial infarction complicated by cardiac arrest and severe cardiogenic shock, particularly when initiated early in combination with timely coronary revascularization.

Conclusion: Early VA-ECMO combined with timely coronary revascularization may improve outcomes in selected patients with acute myocardial infarction complicated by cardiac arrest and cardiogenic shock, serving as an effective bridge to myocardial recovery.