Extracorporeal life support in patients with acute myocardial infarction complicated by cardiogenic shock - Design and rationale of the ECLS-SHOCK trial

Thiele, Holger; Freund, Anne; Giménez, María Rubini; Waha‐Thiele, Suzanne de; Akın, İbrahim; Pöss, Janine; Feistritzer, Hans‐Josef; Fuernau, Georg; Graf, Tobias; Nef, Holger; Hamm, Christian; Böhm, Michael; Lauten, Alexander; Schulze, P. Christian; Voigt, Ingo; Nordbeck, Peter; Felix, Stephan B.; Abel, Peter; Baldus, Stephan; Laufs, Ulrich; Lenk, Karsten; Landmesser, Ulf; Skurk, Carsten; Pieske, Burkert; Tschöpe, Carsten; Hennersdorf, Marcus; Wengenmayer, Tobias; Preusch, Michael; Maier, Lars S.; Jung, Christian; Kelm, Malte; Clemmensen, Peter; Westermann, Dirk; Seidler, Tim; Schieffer, Bernhard; Rassaf, Tienush; Mahabadi, Amir-Abbas; Vasa‐Nicotera, Mariuca; Meincke, Felix; Seyfarth, Melchior; Kersten, Alexander; Rottbauer, Wolfgang; Boekstegers, Peter; Muellenbach, Ralf Michael; Dengler, Thomas J.; Kadel, C; Schempf, Benjamin; Karagiannidis, Christian; Hopf, Hans‐Bernd; Lehmann, Ralf; Bufe, Alexander; Baumanns, Stefan; Öner, Alper; Linke, Axel; Sedding, Daniel; Ferrari, Markus; Bruch, Leonhard; Goldmann, Britta; John, Stefan; Möllmann, Helge; Franz, Jutta; Lapp, Harald; Lauten, Philipp; Noč, Marko; Goslar, Tomaž; Oerlecke, Ilka; Ouarrak, Taoufik; Schneider, Steffen; Desch, Steffen; Zeymer, Uwe; Investigators, Ecls-Shock

doi:10.1016/j.ahj.2021.01.002

Cited by 90 publications

(43 citation statements)

References 29 publications

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“…Importantly, this study included anterior STEMI patients without cardiogenic shock but highlighted the safety of using MCS prior to revascularisation as a novel way to protect the myocardium from ischaemia-reperfusion injury. Early initiation of MCS devices before the onset of cardiogenic shock is currently been studied using Impella in the DanGer shock study [39], or using ECMO in the ECLS-SHOCK, EURO-SHOCK, and the ECMO-CS trials [40][41][42]. Table 3 summarized ongoing trials of patients presenting with CS.…”

Section: Mechanical Circulatory Support In Csmentioning

confidence: 99%

Mechanical circulatory support in acute myocardial infarction complicated by cardiogenic shock

Al‐Atta¹,

Zaidan²,

Abdalwahab³

et al. 2022

Rev. Cardiovasc. Med.

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Patients with acute myocardial infarction (MI) complicated by cardiogenic shock (CS) have poor prognosis. Over the last two decades, there has been some improvement in mortality rates associated with CS. Initial measures to stabilise patients should follow a shock protocol, including therapies such as volume expansion, inotropes/vasopressors, and early coronary revascularisation. The use of mechanical circulatory support (MCS) devices demonstrated better haemodynamic and metabolic profiles for patients with CS. However, these benefits have not been consistently translated into significant reductions in cardiovascular adverse events. This review aims to discuss emerging concepts related to CS including an update on its classification and pathophysiology. The focus is on recent evidence regarding the use of MCS and the timing of initiating in patients with CS.

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Section: Mechanical Circulatory Support In Csmentioning

confidence: 99%

Mechanical circulatory support in acute myocardial infarction complicated by cardiogenic shock

Al‐Atta¹,

Zaidan²,

Abdalwahab³

et al. 2022

Rev. Cardiovasc. Med.

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“…criteria most likely to affect the decision to implant MCS, were defined based on the published enrolment criteria of the trials (Table 1). 6,[11][12][13]…”

Section: Pragmatic Enrolment Criteriamentioning

confidence: 99%

“…[8][9][10] To address the lack of randomised data on the treatment of CS with MCS, three RCTs have been initiated and already include patients: the DanGer-SHOCK trial, the ECLS-SHOCK trial and the EURO-SHOCK trial. [11][12][13] All three trials, similar to the IABP-SHOCK II trial, use dedicated enrolment criteria to select a study population which is at high risk of death due to CS while at the same time avoiding excessive competing risks. Although that optimizes the chances of answering the underlying research question, this might also limit generalisability of the results.…”

Section: Introductionmentioning

confidence: 99%

Eligibility for mechanical circulatory support devices based on current and past randomised cardiogenic shock trials

Schrage

Beer

Savarese

et al. 2021

European J of Heart Fail

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“…The use of ECMO in patients with refractory CS following MI with systolic blood pressure below 75 mmHg on inotropic drugs and IABP after primary coronary angioplasty was associated with a significant reduction in the 30-day mortality rate, from 68% to 33%, and 1-year mortality rate, from 76% to 36% [83]. A prospective, adequately powered, multicenter and randomized ECLS-SHOCK trial will address questions of efficacy and safety of ECMO in addition to early revascularization in acute MI complicated by CS [84]. Further research should be addressed to identifying patients at risk of developing left ventricular distension and pulmonary edema and how to optimally unload or vent the left ventricle during ECMO therapy.…”

Section: Mechanical Circulatory Support For Complicating MImentioning

confidence: 99%

Complicating Acute Myocardial Infarction. Current Status and Unresolved Targets for Subsequent Research

Zalewski

Nowak

Furczyńska

et al. 2021

JCM

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Mechanical reperfusion with primary angioplasty, as the treatment of choice in acute myocardial infarction (MI), is associated not only with a high percentage of full epicardial and tissue reperfusion but also with a very good immediate and long-term clinical outcome. However, the Achilles heel of MI treatment is its ensemble of complications, such as cardiogenic shock due to severe systolic and/or diastolic dysfunction or MI mechanical complications, including perforation of the left ventricular free wall, papillary muscle rupture with acute mitral regurgitation and ventricular septal rupture. They are associated with an increased or, sometimes, with an extremely high mortality rate, determining the overall mortality in an MI patient population. In this review we summarize the mechanisms of MI complications, current therapeutic management and alternative directions for overcoming their devastating consequences. Moreover, we have sought to indicate gaps in the evidence on current treatments as the potential targets for further clinical research. From the perspective of mortality trends that are not improving, the forthcoming therapeutic management of complicated MI will require an individualized and novel approach based on their thorough pathobiology.

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Extracorporeal life support in patients with acute myocardial infarction complicated by cardiogenic shock - Design and rationale of the ECLS-SHOCK trial

Cited by 90 publications

References 29 publications

Mechanical circulatory support in acute myocardial infarction complicated by cardiogenic shock

Mechanical circulatory support in acute myocardial infarction complicated by cardiogenic shock

Eligibility for mechanical circulatory support devices based on current and past randomised cardiogenic shock trials

Complicating Acute Myocardial Infarction. Current Status and Unresolved Targets for Subsequent Research

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