Early Escalation to CentriMag for Acute Myocardial Infarction‐Induced Out‐of‐Hospital Cardiac Arrest With Refractory to Extracorporeal Membrane Oxygen Support

ABSTRACT Objectives The mortality rate of acute myocardial infarction (AMI)‐related refractory cardiogenic shock (rCS) remains high, particularly in patients experiencing cardiac arrest with extracorporeal cardiopulmonary resuscitation (ECPR). This study aimed to evaluate the outcomes of early escalation to CentriMag for AMI‐induced out‐of‐hospital cardiac arrest (OHCA) with ECPR. Methods Patients with AMI‐induced OHCA with refractory to ECMO support after ECPR were enrolled. Clinical data were analyzed to identify predictive factors for mortality and survival benefits. Results Eighty‐nine patients were enrolled, of whom 26 underwent CentriMag implantation. The 1‐year survival rate for those with the implantation was 34.6%. In contrast, those without implantation showed a survival rate of 7.9%. The average time from the initiation of ECPR to CentriMag implantation was 22.5 ± 14.6 h. The surgical mortality group exhibited a larger body surface area, longer intervals from CPR to ECPR, shorter duration of CentriMag support, and higher preoperative serum creatinine and postoperative day 1 serum aspartate aminotransferase levels. A prolonged interval from CPR to ECPR was identified as an independent risk factor for mortality. Extended duration of CentriMag support was associated with improved survival outcomes. Conclusions Early CentriMag implantation rescues patients experiencing AMI‐related OHCA with rCS and refractory to ECMO support after ECPR. This intervention provides a critical time window, serving as a safe bridge to decision.