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Hemodynamics Management

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"Does Early ECMO Therapy Influence Survival in Cardiogenic Shock? An Analysis of Recent Findings"

A randomized Czech Republic trial has recently examined the impact of immediate versus delayed or no venoarterial extracorporeal membrane oxygenation (VA-ECMO) therapy in patients with severe or rapidly worsening cardiogenic shock. Although VA-ECMO can swiftly stabilize hemodynamics in such cases, its definitive impact on survival remains ambiguous.

Patients in the study had predominantly ST-segment–elevation myocardial infarction (50%) or decompensated heart failure (23%). A total of 117 patients, median age 66, were observed over eight years. They found that the incidence of the composite primary end point (death, resuscitated circulatory arrest, and the use of another mechanical circulatory support, including ECMO in conservative-care group) at 30 days did not significantly differ between the immediate ECMO group and the conservative-care group. The mortality rate was also comparable in both groups, and serious adverse events were similarly frequent.

These findings suggest no clear benefits of an early ECMO strategy in patients with severe cardiogenic shock. However, conducting randomized trials in this patient group is challenging due to issues like informed consent and treatment bias. Several more extensive trials are ongoing and will provide additional insights into the optimal treatment approach for these patients with limited options.

Ostadal P et al. Extracorporeal membrane oxygenation in the therapy of cardiogenic shock: Results of the ECMO-CS randomized clinical trial. Circulation 2023 Feb 7; 147:454. ( opens in new tab)

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