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Meta-Analysis
. 2023 Oct 14;402(10410):1338-1346.
doi: 10.1016/S0140-6736(23)01607-0. Epub 2023 Aug 26.

Venoarterial extracorporeal membrane oxygenation in patients with infarct-related cardiogenic shock: an individual patient data meta-analysis of randomised trials

Uwe Zeymer  1 , Anne Freund  2 , Matthias Hochadel  3 , Petr Ostadal  4 , Jan Belohlavek  5 , Richard Rokyta  6 , Steffen Massberg  7 , Stefan Brunner  7 , Enzo Lüsebrink  7 , Marcus Flather  8 , David Adlam  9 , Kris Bogaerts  10 , Amerjeet Banning  11 , Manel Sabaté  12 , Ibrahim Akin  13 , Alexander Jobs  2 , Steffen Schneider  3 , Steffen Desch  2 , Holger Thiele  14
Affiliations
Meta-Analysis

Venoarterial extracorporeal membrane oxygenation in patients with infarct-related cardiogenic shock: an individual patient data meta-analysis of randomised trials

Uwe Zeymer et al. Lancet. .

Abstract

Background: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used in patients with cardiogenic shock despite the lack of evidence from adequately powered randomised clinical trials. Three trials reported so far were underpowered to detect a survival benefit; we therefore conducted an individual patient-based meta-analysis to assess the effect of VA-ECMO on 30-day death rate.

Methods: Randomised clinical trials comparing early routine use of VA-ECMO versus optimal medical therapy alone in patients presenting with infarct-related cardiogenic shock were identified by searching MEDLINE, Cochrane Central Register of Controlled Trials, Embase, and trial registries until June 12, 2023. Trials were included if at least all-cause death rate 30 days after in-hospital randomisation was reported and trial investigators agreed to collaborate (ie, providing individual patient data). Odds ratios (ORs) as primary outcome measure were pooled using logistic regression models. This study is registered with PROSPERO (CRD42023431258).

Findings: Four trials (n=567 patients; 284 VA-ECMO, 283 control) were identified and included. Overall, there was no significant reduction of 30-day death rate with the early use of VA-ECMO (OR 0·93; 95% CI 0·66-1·29). Complication rates were higher with VA-ECMO for major bleeding (OR 2·44; 95% CI 1·55-3·84) and peripheral ischaemic vascular complications (OR 3·53; 95% CI 1·70-7·34). Prespecified subgroup analyses were consistent and did not show any benefit for VA-ECMO (pinteraction ≥0·079).

Interpretation: VA-ECMO did not reduce 30-day death rate compared with medical therapy alone in patients with infarct-related cardiogenic shock, and an increase in major bleeding and vascular complications was observed. A careful review of the indication for VA-ECMO in this setting is warranted.

Funding: Foundation Institut für Herzinfarktforschung.

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Conflict of interest statement

Declaration of interests HT is President of the German Cardiac Society. PO reports lecture fees from Abiomed, Getinge, Edwards, and Xenios/Fresenius. JB reports lecture fees from Abiomed, Resuscitec, and Xenios. DA reports funding to support a clinical research fellow from Abbott Vascular; has received funding from AstraZeneca for unrelated research; has conducted unrelated consultancy for General Electric; holds patents for medical devices, including a cardiac assist device (EP3277337A1, PCT/GB2017/050877, UK patent application number 2211616.4); received royalties from Elsevier for The ECG Made Practical and ECG Problems books; is Chair of the ESC-ACVC SCAD Study Group and ESC-EORP SCAD Registry; and reports participation on an advisory board for Beat SCAD. MS reports consultant fees from Abbott Vascular and iVascular. AB reports that the EURO SHOCK trial received European Commission Horizons 2020 funding (reference number 754946-2), University of Leicester as beneficiary. All other authors declare no competing interests.

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