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. 2024 Jan 18;4(1):oeae003.
doi: 10.1093/ehjopen/oeae003. eCollection 2024 Jan.

The impact of extracorporeal membrane oxygenation on mortality in patients with cardiogenic shock post-acute myocardial infarction: a systematic review and meta-analysis

Sophie Paddock  1   2 , James Meng  1   2 , Nicholas Johnson  2 , Rahul Chattopadhyay  2   3 , Vasiliki Tsampasian  1   2 , Vassilios Vassiliou  1   2
Affiliations

The impact of extracorporeal membrane oxygenation on mortality in patients with cardiogenic shock post-acute myocardial infarction: a systematic review and meta-analysis

Sophie Paddock et al. Eur Heart J Open. .

Abstract

Aims: Cardiogenic shock remains the leading cause of death in patients hospitalized with acute myocardial infarction. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used in the treatment of infarct-related cardiogenic shock. However, there is limited evidence regarding its beneficial impact on mortality. The aim of this study was to systematically review studies reporting the impact of VA-ECMO on mortality in patients with acute myocardial infarction complicated by cardiogenic shock.

Methods and results: A comprehensive search of medical databases (Cochrane Register and PubMed) was conducted. Studies that reported mortality outcomes in patients treated with VA-ECMO for infarct-related cardiogenic shock were included. The database search yielded 1194 results, of which 11 studies were included in the systematic review. Four of these studies, with a total of 586 patients, were randomized controlled trials and were included in the meta-analysis. This demonstrated that there was no significant difference in 30-day all-cause mortality with the use of VA-ECMO compared with standard medical therapy [odds ratio (OR) 0.91; 95% confidence interval (CI) 0.65-1.27]. Meta-analysis of two studies showed that VA-ECMO was associated with a significant reduction in 12-month all-cause mortality (OR 0.31; 95% CI 0.11-0.86). Qualitative synthesis of the observational studies showed that age, serum creatinine, serum lactate, and successful revascularization are independent predictors of mortality.

Conclusion: Veno-arterial extracorporeal membrane oxygenation does not improve 30-day all-cause mortality in patients with cardiogenic shock following acute myocardial infarction; however, there may be significant reduction in all-cause mortality at 12 months. Further studies are needed to delineate the potential benefit of VA-ECMO in long-term outcomes.

Registration: The protocol was registered in the PROSPERO International Prospective Register of Systematic Reviews (ID: CRD42023461740).

Keywords: Acute myocardial infarction; Cardiogenic shock; Extracorporeal membrane oxygenation.

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Conflict of interest statement

Conflict of interest: There are no conflicts of interest related to this work.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram of the study selection process.
Figure 2
Figure 2
Meta-analysis of randomized controlled trials focusing on 30-day all-cause mortality.
Figure 3
Figure 3
Meta-analysis of randomized controlled trials focusing on 12-month all-cause mortality.
See this image and copyright information in PMC

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