上海交通大学学报（医学版） ›› 2026, Vol. 46 ›› Issue (1): 123-131.doi: 10.3969/j.issn.1674-8115.2026.01.015
• 综述 • 上一篇
邓钰莹(
), 黄修献, 王圣
收稿日期:2025-06-30
接受日期:2025-12-19
出版日期:2026-01-28
发布日期:2026-01-30
通讯作者:
邓钰莹，主治医师，硕士；电子信箱：kexuanling@163.com。作者简介:第一联系人：邓钰莹负责文献检索和文章撰写，黄修献参与文献检索及文中表格制作，王圣负责文章的修改。所有作者均阅读并同意了最终稿件的提交。
Deng Yuying(), Huang Xiuxian, Wang Sheng
Received:2025-06-30
Accepted:2025-12-19
Online:2026-01-28
Published:2026-01-30
Contact:
Deng Yuying, E-mail: kexuanling@163.com.About author:First author contact:Deng Yuying was responsible for literature retrieval and manuscript preparation. Huang Xiuxian contributed to literature retrieval and the development of tables in the manuscript. Wang Sheng was responsible for the critical revision of the manuscript. All authors have read the last version of paper and consented to submission.
摘要：
虽然冠状动脉旁路移植术（coronary artery bypass grafting，CABG）是大部分复杂冠脉病变患者的首选治疗方法，但在某些病例，尤其是急危重症、血流动力学不稳定的情况下，机械循环支持（mechanical circulatory support，MCS）下的经皮冠状动脉介入治疗（percutaneous coronary interventions，PCI）可能是不劣于CABG，甚至更优的方案。目前，基于现实世界的观察结果，主动脉内球囊反搏（intra-aortic balloon pump，IABP）这一临床上最常用的循环辅助方式在指南中的推荐地位已经逐步降低。受限于实际硬件条件，Impella在我国尚未推广使用。静脉-动脉体外膜肺氧合（veno-arterial extracorporeal membrane oxygenation，VA-ECMO）得益于其全面而强有力的心肺替代功能，近几年来在我国的应用逐渐普及。该文主要总结不同临床背景下关于VA-ECMO在高危PCI（high-risk PCI，HR-PCI）中应用的研究，为临床工作提供参考和借鉴。
中图分类号:
邓钰莹, 黄修献, 王圣. 不同临床状况下VA-ECMO在高危经皮冠状动脉介入治疗中的应用进展[J]. 上海交通大学学报（医学版）, 2026, 46(1): 123-131.
Deng Yuying, Huang Xiuxian, Wang Sheng. Application of VA-ECMO in high-risk percutaneous coronary interventions under different clinical conditions[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2026, 46(1): 123-131.
| Author | Type of study | Patient | Group | Endpoint | Result |
|---|---|---|---|---|---|
| Haneya A et al[ | 5-year retrospective study | Adult patients treated with ECLS between January 2007 and January 2012 (n=85) | — | — | Mean ECLS support duration was 49 h (12‒92 h). 28 patients (33%) had ECLS-related complications. 40 patients (47%) were successfully weaned and 29 patients (34%) survived to hospital discharge. Among survivors, 93% had no severe neurologic deficit |
| Chung S Y et al[ | Single-center prospective observational study | Patients with profound CS undergoing (10‒15) min of cardiopulmonary cerebral resuscitation (CPCR) and VA-ECMO (n=134) | — | — | Duration of VA-ECMO implantation was 5.1±5.7 days. In-hospital mortality was 57.5%. 68 patients (50.7%) were successfully weaned from VA-ECMO and 57 (42.5%) were discharged alive |
| Bougouin W et al[ | Prospective registry study | Patients with OHCA in the Paris region from May 2011 to January 2018 | Conventional CPR (n=12 666) vs ECPR (n=525) | Survival at hospital discharge | ECPR was not associated with increased hospital survival. Early VA-ECMO implantation may improve outcomes |
| Chen Y S et al[ | 3-year prospective observational study | Patients aged (18‒75) years with witnessed in-hospital cardiac arrest of cardiac origin undergoing CPR of more than 10 min | Conventional CPR group (n=113) vs ECPR group (n=59) | Survival to hospital discharge | Survival to hospital discharge (P<0.000 1), 30-day survival (P=0.003), and 1-year survival (P=0.006) were significantly higher in the ECPR group than in the conventional CPR group |
| Maekawa K et al[ | Post hoc analysis of data from a prospective observational cohort | Patients with witnessed cardiac arrest of cardiac origin who had undergone CPR for longer than 20 min | Conventional CPR group (n=109) vs ECPR group (n=53) | Neurologically intact survival at 3 months after cardiac arrest | Intact survival rate was higher in the matched ECPR group than in the matched conventional CPR group [29.2% (7/24) vs. 8.3% (2/24), log-rank P=0.018] |
| Sakamoto T et al[ | Prospective observational study | OHCA patients | Non-ECPR group (n=20) vs ECPR group(n=26) | Rate of favorable outcomes defined by the Glasgow-Pittsburgh Cerebral Performance Category (CPC) 1 or 2 at 1 and 6 months after OHCA | CPC 1 or 2 rates were 12.3% (32/260) in the ECPR group and 1.5% (3/194) in the non-ECPR group at 1 month (P<0.000 1), and 11.2% (29/260) and 2.6% (5/194) at 6 months (P=0.001), respectively. By per-protocol analysis, CPC 1 or 2 were 13.7% (32/234) in the ECPR group and 1.9% (3/159) in the non-ECPR group at 1 month (P<0.000 1), and 12.4% (29/234) and 3.1% (5/159) at 6 months (P=0.002), respectively |
| Bartos J A et al[ | Retrospective analysis | Adults with refractory ventricular fibrillation/ventricular tachycardia and OHCA | ECPR patients (n=160) vs standard CPR patients (n=654) | Neurologically favorable survival | Neurologically favorable survival was significantly higher in ECPR patients than in standard CPR patients (33% versus 23%;P=0.01) overall |
表1 ECPR的观察性研究总结
Tab 1 Summary of observational studies on ECPR
| Author | Type of study | Patient | Group | Endpoint | Result |
|---|---|---|---|---|---|
| Haneya A et al[ | 5-year retrospective study | Adult patients treated with ECLS between January 2007 and January 2012 (n=85) | — | — | Mean ECLS support duration was 49 h (12‒92 h). 28 patients (33%) had ECLS-related complications. 40 patients (47%) were successfully weaned and 29 patients (34%) survived to hospital discharge. Among survivors, 93% had no severe neurologic deficit |
| Chung S Y et al[ | Single-center prospective observational study | Patients with profound CS undergoing (10‒15) min of cardiopulmonary cerebral resuscitation (CPCR) and VA-ECMO (n=134) | — | — | Duration of VA-ECMO implantation was 5.1±5.7 days. In-hospital mortality was 57.5%. 68 patients (50.7%) were successfully weaned from VA-ECMO and 57 (42.5%) were discharged alive |
| Bougouin W et al[ | Prospective registry study | Patients with OHCA in the Paris region from May 2011 to January 2018 | Conventional CPR (n=12 666) vs ECPR (n=525) | Survival at hospital discharge | ECPR was not associated with increased hospital survival. Early VA-ECMO implantation may improve outcomes |
| Chen Y S et al[ | 3-year prospective observational study | Patients aged (18‒75) years with witnessed in-hospital cardiac arrest of cardiac origin undergoing CPR of more than 10 min | Conventional CPR group (n=113) vs ECPR group (n=59) | Survival to hospital discharge | Survival to hospital discharge (P<0.000 1), 30-day survival (P=0.003), and 1-year survival (P=0.006) were significantly higher in the ECPR group than in the conventional CPR group |
| Maekawa K et al[ | Post hoc analysis of data from a prospective observational cohort | Patients with witnessed cardiac arrest of cardiac origin who had undergone CPR for longer than 20 min | Conventional CPR group (n=109) vs ECPR group (n=53) | Neurologically intact survival at 3 months after cardiac arrest | Intact survival rate was higher in the matched ECPR group than in the matched conventional CPR group [29.2% (7/24) vs. 8.3% (2/24), log-rank P=0.018] |
| Sakamoto T et al[ | Prospective observational study | OHCA patients | Non-ECPR group (n=20) vs ECPR group(n=26) | Rate of favorable outcomes defined by the Glasgow-Pittsburgh Cerebral Performance Category (CPC) 1 or 2 at 1 and 6 months after OHCA | CPC 1 or 2 rates were 12.3% (32/260) in the ECPR group and 1.5% (3/194) in the non-ECPR group at 1 month (P<0.000 1), and 11.2% (29/260) and 2.6% (5/194) at 6 months (P=0.001), respectively. By per-protocol analysis, CPC 1 or 2 were 13.7% (32/234) in the ECPR group and 1.9% (3/159) in the non-ECPR group at 1 month (P<0.000 1), and 12.4% (29/234) and 3.1% (5/159) at 6 months (P=0.002), respectively |
| Bartos J A et al[ | Retrospective analysis | Adults with refractory ventricular fibrillation/ventricular tachycardia and OHCA | ECPR patients (n=160) vs standard CPR patients (n=654) | Neurologically favorable survival | Neurologically favorable survival was significantly higher in ECPR patients than in standard CPR patients (33% versus 23%;P=0.01) overall |
| Author | Patient | Mean support time | Successfully weaned | Survival | Risk of non-weaning VA-ECMO | Risk of mortality |
|---|---|---|---|---|---|---|
| Chung E S et al[ | Patients with CS due to AMI between May 2006 and November 2009 (n=20) | (3.8±4.0) days | 14 (70%) | 10 patients survived to hospital discharge. Survivors had a mean follow-up duration of (476.6±374.6) days | — | Longer CPR duration and ECMO support time, elevated cardiac enzyme levels, lower ejection fraction, lower serum albumin levels, and major complications (P<0.05) |
| Kim H et al[ | Patients requiring VA-ECMO for AMI complicated with CS between April 2006 and July 2010 (n=27) | (30.2±30.1) hours | 22 (81.5%) | 16 patients (59.3%) survived to hospital discharge. The 30-day survival was 63.0% (17/27) | The interval between CPR initiation and VA-ECMO commencement | High pre-ECMO serum lactate level |
Wu M Y et al[ | Patients rescued by VA-ECMO for AMI-induced cardiopulmonary collapse between June 2003 and December 2011 (n=35) | [66 (2‒259)] hours for PCI and [100 (43‒504)] hours for CABG | 22 (63%) | The hospital discharge rate was 40%. Major adverse cardiovascular event (MACE)-free survival was 77% in the first year after discharge | Dialysis-dependent acute renal failure (OR=5.4, 95% CI: 1.1‒27.5) and profound anoxic encephalopathy (OR=5.3, 95% CI: 1.2‒27.3) | Age>60 years (OR=7.3, 95% CI: 1.1‒51.0) and profound anoxic encephalopathy (OR=24.6, 95% CI: 2.3‒263.0) |
| Chung S Y et al[ | STEMI patients with profound CS who underwent routine ECMO-supported primary PCI between December 2005 and December 2014 (n=65) | (6.8±7.5) days for 30-day survivors and (4.9±4.0) days for 30-day non-survivors | 45 (69.2%) | The long-term cumulative survival rate was 32.3% (21/65) with a mean follow-up of (734±987) days | — | Unsuccessful reperfusion, failed VA-ECMO weaning, and peak creatinine level (all P<0.01) |
| Sakamoto S et al[ | ACS patients who received ECLS to reverse hemodynamic collapse refractory to conventional treatment (n=98) | (68.9±62.7) hours | 54 (55.1%) | The survival rate to hospital discharge was 32.7% | — | Unsuccessful angioplasty, asystole or pulseless electrical activity before ECLS initiation, and ECLS-related complications |
表2 VA-ECMO应用于AMI合并CS的观察性研究总结
Tab 2 Summary of observational studies on VA-ECMO for AMI complicated with CS
| Author | Patient | Mean support time | Successfully weaned | Survival | Risk of non-weaning VA-ECMO | Risk of mortality |
|---|---|---|---|---|---|---|
| Chung E S et al[ | Patients with CS due to AMI between May 2006 and November 2009 (n=20) | (3.8±4.0) days | 14 (70%) | 10 patients survived to hospital discharge. Survivors had a mean follow-up duration of (476.6±374.6) days | — | Longer CPR duration and ECMO support time, elevated cardiac enzyme levels, lower ejection fraction, lower serum albumin levels, and major complications (P<0.05) |
| Kim H et al[ | Patients requiring VA-ECMO for AMI complicated with CS between April 2006 and July 2010 (n=27) | (30.2±30.1) hours | 22 (81.5%) | 16 patients (59.3%) survived to hospital discharge. The 30-day survival was 63.0% (17/27) | The interval between CPR initiation and VA-ECMO commencement | High pre-ECMO serum lactate level |
Wu M Y et al[ | Patients rescued by VA-ECMO for AMI-induced cardiopulmonary collapse between June 2003 and December 2011 (n=35) | [66 (2‒259)] hours for PCI and [100 (43‒504)] hours for CABG | 22 (63%) | The hospital discharge rate was 40%. Major adverse cardiovascular event (MACE)-free survival was 77% in the first year after discharge | Dialysis-dependent acute renal failure (OR=5.4, 95% CI: 1.1‒27.5) and profound anoxic encephalopathy (OR=5.3, 95% CI: 1.2‒27.3) | Age>60 years (OR=7.3, 95% CI: 1.1‒51.0) and profound anoxic encephalopathy (OR=24.6, 95% CI: 2.3‒263.0) |
| Chung S Y et al[ | STEMI patients with profound CS who underwent routine ECMO-supported primary PCI between December 2005 and December 2014 (n=65) | (6.8±7.5) days for 30-day survivors and (4.9±4.0) days for 30-day non-survivors | 45 (69.2%) | The long-term cumulative survival rate was 32.3% (21/65) with a mean follow-up of (734±987) days | — | Unsuccessful reperfusion, failed VA-ECMO weaning, and peak creatinine level (all P<0.01) |
| Sakamoto S et al[ | ACS patients who received ECLS to reverse hemodynamic collapse refractory to conventional treatment (n=98) | (68.9±62.7) hours | 54 (55.1%) | The survival rate to hospital discharge was 32.7% | — | Unsuccessful angioplasty, asystole or pulseless electrical activity before ECLS initiation, and ECLS-related complications |
| Author | Type of study | Patient | Mean age | Male | Duration of VA-ECMO | ECMO-related complication | Mortality of MACCE/MACE |
|---|---|---|---|---|---|---|---|
Shaukat A et al[ | Single-center experience | n=5 | (66.8±8.6) years | 5 (100%) | <24 hours in 4 cases | 1 patient required femoral artery surgical repair | There was no occurrence of in-hospital and 1-year MACCE |
| Tomasello S D et al[ | Single-center experience | n=12 | (63.5±8.7) years | 8 (66.7%) | (95.4±25.2) min | A groin hematoma at the arterial cannulation site (BARC type 2) occurred in 1 patient (8.3%). Worsening renal function occurred in 4 patients (33.3%) | No in-hospital MACCE was observed. At 6 months, neither death nor MI was reported |
| Van Den Brink F S et al[ | Two-center retrospective study | n=14 | [69 (53‒83)] years | 13 (92%) | [2.57 (1‒4)] hours | 1 patient developed a transient ischemic attack after the procedure and 1 patient developed a thrombus in the femoral vein used for cannulation several days after decannulation | Survival was 93% (13/14). One patient died during hospitalization due to refractory cardiac failure |
| Griffioen A M et al[ | Single-centre registry | n=14 | (66.5±2.5) years | 10 (71.4%) | (151±32) min | A minor vascular complication at the vascular access site occurred in 1 patient (7.1%) | MACE during hospital stay occurred in 4 patients (28.6%) and within 60 days after discharge in 2 patients (16.7%) |
表3 VA-ECMO辅助的HR-PCI观察性研究总结
Tab 3 Summary of observational studies on VA-ECMO assisted HR-PCI
| Author | Type of study | Patient | Mean age | Male | Duration of VA-ECMO | ECMO-related complication | Mortality of MACCE/MACE |
|---|---|---|---|---|---|---|---|
Shaukat A et al[ | Single-center experience | n=5 | (66.8±8.6) years | 5 (100%) | <24 hours in 4 cases | 1 patient required femoral artery surgical repair | There was no occurrence of in-hospital and 1-year MACCE |
| Tomasello S D et al[ | Single-center experience | n=12 | (63.5±8.7) years | 8 (66.7%) | (95.4±25.2) min | A groin hematoma at the arterial cannulation site (BARC type 2) occurred in 1 patient (8.3%). Worsening renal function occurred in 4 patients (33.3%) | No in-hospital MACCE was observed. At 6 months, neither death nor MI was reported |
| Van Den Brink F S et al[ | Two-center retrospective study | n=14 | [69 (53‒83)] years | 13 (92%) | [2.57 (1‒4)] hours | 1 patient developed a transient ischemic attack after the procedure and 1 patient developed a thrombus in the femoral vein used for cannulation several days after decannulation | Survival was 93% (13/14). One patient died during hospitalization due to refractory cardiac failure |
| Griffioen A M et al[ | Single-centre registry | n=14 | (66.5±2.5) years | 10 (71.4%) | (151±32) min | A minor vascular complication at the vascular access site occurred in 1 patient (7.1%) | MACE during hospital stay occurred in 4 patients (28.6%) and within 60 days after discharge in 2 patients (16.7%) |
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