Non-invasive mechanical ventilation for reperfusion myocardial injury prevention after endovascular surgeries in patients with ST-elevation myocardial infarction (STEMI)

Abstract

Aim. To determine the need for pressure controlled non-invasive mechanical ventilation for reperfusion myocardial injury prevention in patients with ST-elevation myocardial infarction (STEMI). Methods. The study enrolled 61 patients admitted to the intensive care unit within 6 hours from the debut of chest pain, ST-segment elevation on electrocardiogram and oxygen saturation less than 90%. A percutaneous coronary intervention on an affected coronary artery was performed in all patients 30-90 minutes from admission. Non-invasive mechanical ventilation using the «MAQUET Servo-s» machine was started in patients of the first group (31 patients, mean age 66.3±10.7 years, males - 19, females - 12) with positive end expiratory pressure of 2-6 cm H2O, pressure support of 6-10 cm H2O, 40-60% O2 gas mix. Patients of the second group (comparison group, 30 patients, mean age 63.5±9.8 years, males - 16, females - 14) were offered a conventional treatment of ST-elevation myocardial infarction, including inhalations of humidified oxygen (6-8 liters per minute) using a nasal cannula. Results. Systolic, diastolic blood pressure and heart rate were 123.0±9.4 mm Hg, 81.2±11.3 mm Hg, 70.1±6.1 beats per minute in patients of the first group in 6 hours after admission. In patients of the comparison group the following parameters were measured as 157±12.4 mm Hg, 90.2±10.1 mm Hg, 92.6±10.2 beats per minute. The absolute risk increase of arrhythmias related to reperfusion myocardial injury was 17.8% (р <0.05) for the patients from the second group. Ejection fraction on a transthoracic echocardiogram (Teichholz method) was measured as 47.0±4.0 and 60.5±7.4% in patients from the first and the second groups respectively (р <0.05). Conclusion. Non-invasive mechanical ventilation decreases the risk for arrhythmias related to reperfusion myocardial injury, and increases the ejection fraction compared to conventional treatment and can be applied in patients with STEMI.

Keywords

acute coronary syndrome / STEMI / myocardial infarction / percutaneous coronary intervention / non-invasive mechanical ventilation / reperfusion myocardial injury

References

[1] Клинические рекомендации. Кардиология / Под ред. Ю.Н. Беленкова, Р.Г. Оганова. - М.: ГЭОТАР-Медиа, 2007. - 640 с.

[2] Руксин В.В. Неотложная кардиология. - М.: ГЭОТАР-МЕД, 2007. - 512 с.

[3] Сатишур О.Е. Механическая вентиляция лёгких. - М.: Мед. лит., 2011. - 352 с.

[4] Ухолкина Г.Б., Костянов И.Ю., Кучкина Н.Д. и др. Влияние оксигенотерапии в сочетании с реперфузией на течение острого инфаркта миокарда // Кардиология. - 2005. - №5. - С. 59-66.

[5] Ухолкина Г.Б., Костянов И.Ю., Кучкина Н.Д. и др. Оксигенотерапия в комплексе с эндоваскулярной реперфузией в ранние часы острого инфаркта миокарда: клинико-лабораторные сопоставления // Междун. ж. интервенц. кардиоангиол. - 2005. - №9. - С. 51-60.

[6] Чазов Е.И., Беленков Ю.Н. Рациональная фармакотерапия сердечно-сосудистых заболеваний. - М.: Литтерра, 2004. - 972 с.

[7] 2007 Focused Update of the ACC/AHA 2004 Guidelines for the management of patients with ST-elevation myocardial infarction. ACC/AHA practice guidelines // Сirculation. - 2008. - Vol. 117, N 2. - Р. 296-329.

[8] Braunwald E. Heart Disease. - W.B. Saunders company, 1980. - P. 585-586.

[9] Guidelines on the diagnosis and treatment of acute heart failure - full text. The Task Force on Acute Heart Failure of the European Society of Cardiology. Endorsed by the European Society of Intensive Care Medicine (ESICM) // Eur. Heart J. - 2007. - Vol. 26. - P. 384-416.

[10] Management of acute myocardial infarction in patients presentings with ST-segment elevation. The Task Force on the management of acute myocardial infarction of the European Society of cardiology // Eur. Heart J. - 2003. - Vol. 24. - P. 28-66.

[11] Mohamed M., Andrzej S., Kosinski et al. Reperfusion ventricular arrhythmia «bursts» in TIMI 3 flow restoration with primary angioplasty for anterior ST-elevation myocardial infarction: a more precise definition of reperfusion arrhythmias // Oxford J. Medicine. - 2008. - Vol. 10. - P. 988-997.

[12] Masip J., Roque M., Sanchez B. et al. Noninvasive ventilation in acute cardiogenic pulmonary edema - systematic review and meta-analysis // JAMA. - 2005. - Vol. 294. - P. 3124-3130.

[13] Philip-Joet F.F., Paganelli F.F., Dutau H.L., Saadjian A.Y. Hemodynamic effects of bilevel nasal positive airway pressure ventilation in patients with heart failure // Respiration. - 1999. - Vol. 66. - P. 136-143.

[14] Rasanen J., Heikkila J., Downs J. et al. Continuous positive airway pressure by face mask in acute cardiogenic pulmonary edema // Am. J. Cardiol. - 1985. - Vol. 55. - P. 296-300.

[15] Winck J.C., Azevedo L.F., Costa-Pereira A. et al. Efficacy and safety of non-invasive ventilation in the treatment of acute cardiogenic pulmonary edema: a systematic review and meta-analysis // Crit. Care. - 2006. - Vol. 10. - P. 2-10.

RIGHTS & PERMISSIONS

Neimark M.I., Zayashnikov S.V., Kalugina O.A., Berestennikova L.N.