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Randomized Controlled Trial
. 2025 Mar 24;18(6):691-701.
doi: 10.1016/j.jcin.2024.12.010.

Different Mechanical Circulatory Support Strategies for Infarct-Related Cardiogenic Shock: A Subanalysis of the ECLS-SHOCK Trial

Hans-Josef Feistritzer  1 , Uwe Zeymer  2 , Taoufik Ouarrak  3 , Ibrahim Akin  4 , Tienush Rassaf  5 , Ralf Lehmann  6 , Ingo Eitel  7 , Tim Seidler  8 , Carsten Skurk  9 , Peter Clemmensen  10 , Ingo Voigt  11 , Melchior Seyfarth  12 , Axel Linke  13 , Eike Tigges  14 , Christian Jung  15 , Philipp Lauten  16 , Janine Pöss  17 , Steffen Schneider  3 , Steffen Desch  17 , Anne Freund  17 , Holger Thiele  17 ; ECLS-SHOCK Investigators
Affiliations
Randomized Controlled Trial

Different Mechanical Circulatory Support Strategies for Infarct-Related Cardiogenic Shock: A Subanalysis of the ECLS-SHOCK Trial

Hans-Josef Feistritzer et al. JACC Cardiovasc Interv. .

Abstract

Background: Mechanical circulatory support (MCS) devices are frequently used in patients with acute myocardial infarction complicated by cardiogenic shock. In clinical practice, escalation of MCS device therapy is performed in a significant proportion of patients aiming to improve hemodynamic status.

Objectives: The aim of this study was to analyze outcomes of different MCS device strategies in the ECLS-SHOCK (Extracorporeal Life Support in Cardiogenic Shock) trial.

Methods: The present subanalysis from the ECLS-SHOCK trial analyzed outcomes of patients treated with upfront extracorporeal life support (ECLS) only, bailout MCS, and escalated MCS therapy. The primary outcome was 30-day all-cause mortality.

Results: Upfront ECLS only, bailout MCS, and escalated MCS therapy were used in 165 (78.9%), 54 (26.0%), and 27 (12.9%) patients, respectively. Thirty-day all-cause mortality was 44.8% (95% CI: 37.1%-52.8%), 61.1% (95% CI: 46.9%-74.1%), and 55.6% (95% CI: 35.3%-74.5%) in the upfront ECLS, bailout MCS, and escalated MCS group (P = 0.09). Need for renal replacement therapy was higher in the bailout MCS (35.2%; 95% CI: 22.7%-49.4%) than in upfront ECLS (7.3%; 95% CI: 3.8%-12.4%) and escalated MCS (14.8%; 95% CI: 4.2%-33.8%) (P < 0.001). Moderate or severe bleeding complications were similar in the upfront ECLS (25.5%; 95% CI: 19.0%-32.8%), bailout MCS (22.2%; 95% CI: 12.0%-35.6%), and escalated MCS (22.2%; 95% CI: 8.6%-42.3%) group (P = 0.86).

Conclusions: Bailout and escalated MCS therapy is associated with numerically higher 30-day mortality compared with upfront ECLS use only. Bailout MCS use is also associated with higher need for renal replacement therapy. (Extracorporeal Life Support in Cardiogenic Shock [ECLS-SHOCK]; NCT03637205).

Keywords: cardiogenic shock; extracorporeal life support; mechanical circulatory support; myocardial infarction; venoarterial extracorporeal membrane oxygenation.

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Conflict of interest statement

Funding Support and Author Disclosures This research was supported by the Else Kröner Fresenius Foundation, the German Heart Research Foundation, and the Helios Health Institute (formerly the Leipzig Heart Institute). The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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