Use of ECMO on Patient with Acute Myocardial Infarction

History

A female patient in her 50s arrived at the emergency department after experiencing one hour of severe, new-onset substernal chest pain. An EKG revealed inferior ST segment elevations, consistent with acute myocardial infarction.

The interventional cardiology team was mobilized immediately, and the patient was swiftly taken for emergent cardiac catheterization. There, a critical thrombotic occlusion of the large circumflex artery was identified and treated with a drug-eluting stent.

Just after the stent was deployed, the patient suddenly went into ventricular fibrillation. She was promptly defibrillated and stabilized with mechanical ventilation and an intra-aortic balloon pump, yet her condition continued to deteriorate. Her blood pressure dropped and right heart catheterization revealed severely reduced cardiac output. Despite escalating inotropic and vasopressor support, she demonstrated worsening acidosis and signs of progressive cardiogenic shock.

Treatment

It was at that moment that the strength of Rush’s multidisciplinary Shock Team came into full force. Cardiac surgeons, advanced heart failure specialists and interventional cardiologists gathered in the Rush Cath Lab at the patient’s bedside for multidisciplinary discussion. They initiated venoarterial extracorporeal membrane oxygenation (ECMO), a form of advanced mechanical circulatory support.

Outcome

Within hours, her hemodynamics improved dramatically. By the next morning, the patient's acidosis had resolved, and vasopressors had been weaned. She was extubated later that day. Over the next several days, her kidney and liver function rebounded and her heart began to recover.

By ECMO day 3, the patient demonstrated adequate myocardial recovery, was weaned from ECMO, and was successfully decannulated. Just one week later, she was discharged home — alive, alert and recovering. Today, she has returned to her active lifestyle, including work and recreational scuba diving.

Analysis

This case highlights the outstanding clinical outcomes achieved by our Shock Team at Rush. With our expert multidisciplinary team of cardiac surgeons, interventional cardiologists and advanced heart failure cardiologists working in seamless collaboration, we assess and support patients in both cardiac and respiratory failure. We are always available for consultation and can facilitate the transport of critically ill patients from both inside and outside the Rush system.

Our patient’s recovery is not only a testament to modern technology but to the power of teamwork — a seamless collaboration between disciplines, each bringing critical expertise in a moment of crisis. At Rush, this is what defines the Shock Team: not just saving lives, but restoring them fully.