Title: Salvage PCI and ECMO for shock-refractory ventricular fibrillation in STEMI
题目：挽救PCI和ECMO在STEMI伴电除颤无效性室颤时的应用
Author 作者: Ali Farzad

The primary goal in management of STEMI is rapid coronary revascularization. STEMI's are occasionally complicated by ventricular fibrillation (VF) arrest. High quality chest compressions and early defibrillation will improve survival. But what can be done in cases where conventional ACLS measures fail and patients have shock-refractory VF?
治疗STEMI的首要目标是快速冠状动脉血运重建。 STEMI偶尔会并发心室颤动（ VF ）心脏骤停。高质量的胸部按压和早期除颤将提高生存率。但是， 在常规ACLS措施失败或病人出现除颤无效的VF情况下，可采取什么措施哪？
Some have suggested that emergent PCI with ongoing CPR en route may be beneficial. This option may be considered in close consultation with cardiology if the arrest is thought to be driven by ongoing ischemia and infarction. However, definitive data is lacking and this has only been described in a handful of case reports.
有些人认为，对在转运途中进行心肺复苏的病人进行紧急PCI可能是有意的。如果认为心脏骤停是由于持续缺血和梗死造成的，在与心内科医生密切磋商后，可考虑此项选择。然而，缺乏确切的数据，这也只是在极少数的病例报告报告中描述过。
There may also be a role for venoarterial ECMO to aid in perfusion of vital organs and limit the risk of multisystem organ failure. The ECMO circuit can also help facilitate therapeutic hypothermia after the culprit vessel(s) is revascularized and rhythm is restored. 
静动脉ECMO在保证重要器官灌注和减少多器官衰竭风险方面可能是有作用的。 在血运重建和心律恢复后还可以利用ECMO的管路进行低温治疗。
Chances for survival are highest in younger patients, those that do not have chronic illnesses, and those who received immediate CPR after arrest. 
年轻，没有慢性疾病，和骤停后立即进行复苏的患者的生存率是最高的。
Summary 结论:
Consider emergent consultation for salvage PCI and ECMO in select cases of shock-refractory ventricular fibrillation associated with STEMI
在STEMI伴除颤无效性室颤情况下，可考虑做紧急挽救PCI和ECMO。
References 参考文献：
A recently published case report (attached) presents a fascinating case where salvage PCI and ECMO were used for shock-refractory VF. The patient survives with good neurological outcome. It highlights the multidisciplinary cooperation and resources necessary to utilize these heroic practices. 
Brown DFM, Jaffer FA, Baker JN, Gurol ME. Case records of the Massachusetts General Hospital. Case 28-2013. A 52-year-old man with cardiac arrest after an acute myocardial infarction. N Engl J Med. 2013;369(11):1047–1054. doi:10.1056/NEJMcpc1304164.