The following is a summary of “Extracorporeal Life Support in Infarct-Related Cardiogenic Shock,” published in the August 2023 issue of Critical Care by Thiele et al.

Researchers performed a retrospective study to evaluate the effect of extracorporeal life support (ECLS) on mortality in patients with infarct-related cardiogenic shock.

They conducted a multicenter trial involving patients with acute myocardial infarction complicated by cardiogenic shock, with early revascularization. Patients were randomly allocated to receive early ECLS in addition to usual medical treatment (ECLS group) or usual medical therapy alone (control group). The primary outcome was 30-day mortality. Safety outcomes included bleeding, stroke, and peripheral vascular complications requiring intervention.

The results showed 420 randomized patients, and 417 were included in the final analyses. In 30 days, death occurred in 47.8% (100/209) of the ECLS group and 49.0% (102/208) of the control group. (relative risk, 0.98; 95% CI, 0.80 to 1.19; P=0.81). The median time of mechanical ventilation was 7 days (interquartile range, 4 to 12) in the ECLS group and 5 days (interquartile range, 3 to 9) in the control group, with a median difference of 1 day (95% CI, 0 to 2). The safety outcome, with moderate or severe bleeding, was seen in 23.4% of ECLS group patients and 9.6% of control group patients. (relative risk, 2.44; 95% CI, 1.50 to 3.95). Peripheral vascular complications necessitating intervention occurred in 11.0% of patients in the ECLS group and 3.8% in the control group (relative risk, 2.86; 95% CI, 1.31 to 6.25).

They concluded that ECLS does not improve mortality in cardiogenic shock patients scheduled for early revascularization.

Source: nejm.org/doi/full/10.1056/NEJMoa2307227