冠脉介入患者术中接受静脉-动脉体外膜氧合联合主动脉内球囊反搏支持的疗效分析OA

Objective To evaluate the clinical efficacy and short-term prognosis impact of veno-arterial extracorporeal membrane oxygenation(V-A ECMO)combined with intra-aortic balloon pump(IABP)support in patients experiencing acute hemodynamic instability during percutaneous coronary intervention(PCI).Methods A retrospective cohort study was conducted,including 73 patients who received mechanical circulatory support due to sudden hemodynamic deterioration during elective or emergency PCI and at our center from January 2020 to December 2024.Patients were categorized into two groups based on the support modality:the combination group(V-A ECMO+IABP,n=28)and the IABP-only group(n=45).Baseline characteristics,PCI-related parameters,intraoperative lowest mean arterial pressure(MAP),lactate levels,heart rate,postoperative 24-hour arterial blood gas parameters(pH,PaO2,lactate),ICU stay duration,weaning success rate,complication rates,and 28-day survival were collected and compared.Student's t-test,χ2 test,logistic regression,Kaplan-Meier survival analysis,and receiver operating characteristic(ROC)curve were employed to evaluate intervention efficacy and prognostic factors.Results No significant differences were observed in baseline characteristics between the two groups(all P>0.05).The combination group had a significantly lower intraoperative MAP compared to the control group(54.37±7.12 mmHg vs.61.09±6.38 mmHg,P=0.002),and a higher lactate level at 1 hour post-procedure(5.94±1.83 vs.4.27±1.58 mmol/L,P=0.008).However,the 6-hour lactate clearance was significantly greater in the combination group(-2.12±0.94 vs.-1.18±0.88 mmol/L,P=0.004).The 28-day survival rate was higher in the combination group(75.00%)than in the IABP-only group(57.78%,P=0.048).Univariate logistic regression analysis identified treatment modality,6-hour lactate level,24-hour pH,Killip class,and intraoperative MAP as potential predictors of 28-day mortality(all P<0.05).Multivariate analysis confirmed that combined V-A ECMO+IABP support(OR=0.30,95%CI:0.10-0.89,P=0.030)and 6-hour lactate level(OR=1.51,95%CI:1.10-2.08,P=0.012)were independent predictors of 28-day mortality.ROC analysis demonstrated that 6-hour lactate level had good predictive value for 28-day mortality,with an AUC of 0.812(95%CI:0.716-0.908,P<0.001),an optimal cut-off of 4.63 mmol/L,sensitivity of 84.21%,and specificity of 73.81%.Conclusion For high-risk patients experiencing acute hemodynamic instability during PCI,V-A ECMO combined with IABP support provides superior early circulatory stabilization,facilitates more effective lactate clearance,and improves short-term survival compared to IABP alone.The 6-hour post-procedural lactate level serves as a valuable early predictor of mortality,highlighting the clinical significance of this combined strategy in critically ill PCI populations.