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. 2025 Jul 2;13(1):38.
doi: 10.1186/s40560-025-00807-w.

Prognostic implication of venoarterial extracorporeal membrane oxygenation in acute myocardial infarction-related cardiogenic shock

Jonghu Shin #  1 , Eun-Mi Kang #  1   2 , Sang-Hyup Lee #  1 , Minju Heo  3 , Yong-Joon Lee  1 , Seung-Jun Lee  1 , Sung-Jin Hong  1 , Jung-Sun Kim  1 , Byeong-Keuk Kim  1 , Young-Guk Ko  1 , Donghoon Choi  1 , Myeong-Ki Hong  1 , Yangsoo Jang  4 , Chul-Min Ahn  5
Affiliations

Prognostic implication of venoarterial extracorporeal membrane oxygenation in acute myocardial infarction-related cardiogenic shock

Jonghu Shin et al. J Intensive Care. .

Abstract

Background: Given the conflicting results regarding the clinical outcomes of venoarterial extracorporeal membrane oxygenation (VA-ECMO) based on etiology, its benefit for patients with cardiogenic shock (CS) remains controversial. This study aimed to report the real-world clinical outcomes of VA-ECMO treatment for patients with CS, based on the presence of acute myocardial infarction (AMI).

Methods: Patients treated with peripheral VA-ECMO between 2008 and 2023 at a tertiary cardiovascular center were included and classified into two groups based on CS etiology (AMI-CS and non-AMI-CS). Logistic regression models were used to compare in-hospital mortality and to identify prognostic predictors.

Results: Among the 667 patients included, 264 (39.6%) were classified as having AMI-CS. The rate of cardiac arrest before VA-ECMO initiation was higher in the AMI-CS group than in the non-AMI-CS group (69.7% vs. 55.8%; P < 0.001). Patients in the AMI-CS group were older (66 vs. 61 years; P < 0.001), more likely to be male (82.6% vs. 57.3%; P < 0.001), and had a lower left ventricular (LV) ejection fraction (20% vs. 25%; P < 0.001) than those in the non-AMI-CS group. The AMI-CS group had a lower in-hospital mortality rate (58.6% vs. 69.7%; odds ratio, 0.46; 95% confidence interval, 0.29-0.75; P = 0.002) compared with the non-AMI-CS group. The independent predictors of favorable clinical outcomes after VA-ECMO included younger age, shorter cardiac arrest duration, absence of severe LV dysfunction, absence of renal replacement therapy, higher hemoglobin levels, higher arterial pH, and lower lactate levels. The association between in-hospital mortality and AMI-CS was also demonstrated in the propensity score matching analysis.

Conclusions: In this single-center study, AMI-CS was associated with a lower in-hospital mortality than non-AMI-CS after VA-ECMO treatment.

Keywords: Cardiac arrest; Cardiogenic shock; Extracorporeal membrane oxygenation; Lactate.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study protocol was approved by the Institutional Review Board of Yonsei University and was performed in accordance with the Declaration of Helsinki. The requirement for informed consent was waived due to the retrospective nature of this study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of patient inclusion in this study. Patients with CS treated with peripheral VA-ECMO were included. The included patients were classified into the AMI-CS and non-AMI-CS groups based on the etiology of CS. AMI, acute myocardial infarction; CS, cardiogenic shock; VA-ECMO, venoarterial extracorporeal membrane oxygenation
Fig. 2
Fig. 2
In-hospital mortality according to CS etiology. The bar graph compares in-hospital mortality rates between the AMI-CS and non-AMI-CS groups. The P-value was calculated using a multivariate logistic regression analysis. AMI, acute myocardial infarction; CI, confidence interval; CS, cardiogenic shock; OR, odds ratio
Fig. 3
Fig. 3
Prognostic Implication of VA-ECMO in cardiogenic shock. This study compares mortality in patients treated with VA-ECMO for CS, with and without AMI. Patients with AMI were associated with lower in-hospital mortality. Higher hemoglobin level was associated with favorable outcomes, whereas old age, prolonged cardiac arrest, severe LV dysfunction, renal replacement therapy, arterial pH < 7.2, and lactate levels over 8.0 mmol/L were associated with unfavorable outcomes. AMI, acute myocardial infarction; CS, cardiogenic shock; LV, left ventricle; VA-ECMO, venoarterial extracorporeal membrane oxygenation
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