Extracorporeal Membrane Oxygenation in Infarct-Related Cardiogenic Shock

Freund, Anne; Desch, Steffen; Pöss, Janine; Sulimov, Dmitry; Sandri, Monica; Majunke, Nicolas; Thiele, Holger

doi:10.3390/jcm11051256

Cited by 7 publications

(5 citation statements)

References 68 publications

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“…Physiologically, systemic organ perfusion is improved. [3,4] Venoarterial extracorporeal membrane oxygenation therapy in acute myocardial infarction As a form of temporary MCS, VA-ECMO could provide cardiopulmonary support. In patients with AMI, VA-ECMO is suggested for temporary support with the potential for functional recovery.…”

Section: Basic Operating Principle Of Venoarterial Extracorporeal Mem...mentioning

confidence: 99%

Venoarterial extracorporeal membrane oxygenation in acute myocardial infarction

Xing¹

2024

Emerg Crit Care Med

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Section: Basic Operating Principle Of Venoarterial Extracorporeal Mem...mentioning

confidence: 99%

Venoarterial extracorporeal membrane oxygenation in acute myocardial infarction

Xing¹

2024

Emerg Crit Care Med

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“…The need for more randomized controlled trials on this topic has given rise to the three largest studies analyzing the impact of VA-ECMO on the mortality of patients with CS complicating AMI [ 21 ] ( Table 2 ).…”

Section: New Updates and Highlights About The Role Of Va-ecmo In Csmentioning

confidence: 99%

Extracorporeal Life Support in Myocardial Infarction: New Highlights

Piccone,

Schiavoni,

Mattei

et al. 2024

Medicina

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Background and Objectives: Cardiogenic shock (CS) is a potentially severe complication following acute myocardial infarction (AMI). The use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in these patients has risen significantly over the past two decades, especially when conventional treatments fail. Our aim is to provide an overview of the role of VA-ECMO in CS complicating AMI, with the most recent literature highlights. Materials and Methods: We have reviewed the current VA-ECMO practices with a particular focus on CS complicating AMI. The largest studies reporting the most significant results, i.e., overall clinical outcomes and management of the weaning process, were identified in the PubMed database from 2019 to 2024. Results: The literature about the use of VA-ECMO in CS complicating AMI primarily has consisted of observational studies until 2019, generating the need for randomized controlled trials. The EURO-SHOCK trial showed a lower 30-day all-cause mortality rate in patients receiving VA-ECMO compared to those receiving standard therapy. The ECMO-CS trial compared immediate VA-ECMO implementation with early conservative therapy, with a similar mortality rate between the two groups. The ECLS-SHOCK trial, the largest randomized controlled trial in this field, found no significant difference in mortality at 30 days between the ECMO group and the control group. Recent studies suggest the potential benefits of combining left ventricular unloading devices with VA-ECMO, but they also highlight the increased complication rate, such as bleeding and vascular issues. The routine use of VA-ECMO in AMI complicated by CS cannot be universally supported due to limited evidence and associated risks. Ongoing trials like the Danger Shock, Anchor, and Recover IV trials aim to provide further insights into the management of AMI complicated by CS. Conclusions: Standardizing the timing and indications for initiating mechanical circulatory support (MCS) is crucial and should guide future trials. Multidisciplinary approaches tailored to individual patient needs are essential to minimize complications from unnecessary MCS device initiation.

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“…3 Despite major improvements and advances in interventional and medical treatment of AMI, the mortality in infarct-related CS remains high, reaching 40-50%. 4,5 Anaemia is prevalent among cardiovascular patients and can lead to reduced oxygen tissue delivery, impaired oxygen utilization, and chronic tissue ischaemia. 6 patients worldwide and has been associated with adverse outcomes in cardiovascular diseases.…”

Section: Introductionmentioning

confidence: 99%

“…Microcirculatory hypoperfusion and reduced tissue oxygen delivery represent the most prominent steps in the pathophysiological cascade of CS and the degree of impairment is associated with unfavourable outcome in CS patients 3 . Despite major improvements and advances in interventional and medical treatment of AMI, the mortality in infarct‐related CS remains high, reaching 40–50% 4,5 …”

Section: Introductionmentioning

confidence: 99%

Impact of anaemia and iron deficiency on outcomes in cardiogenic shock complicating acute myocardial infarction

Obradovic,

Loncar,

Zeymer

et al. 2024

European J of Heart Fail

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AimsAnaemia and iron deficiency (ID) are common comorbidities in cardiovascular patients and are associated with a poor clinical status, as well as a worse outcome in patients with heart failure and acute myocardial infarction (AMI). Nevertheless, data concerning the impact of anaemia and ID on clinical outcomes in patients with cardiogenic shock (CS) are scarce. This study aimed to assess the impact of anaemia and ID on clinical outcomes in patients with CS complicating AMI.Methods and resultsThe presence of anaemia (haemoglobin <13 g/dl in men and <12 g/dl in women) or ID (ferritin <100 ng/ml or transferrin saturation <20%) was determined in patients with CS due to AMI from the CULPRIT‐SHOCK trial. Blood samples were collected in the catheterization laboratory during initial percutaneous coronary intervention. Clinical outcomes were compared in four groups of patients having neither anaemia nor ID, against patients with anaemia with or without ID and patients with ID only. A total of 427 CS patients were included in this analysis. Anaemia without ID was diagnosed in 93 (21.7%), anaemia with ID in 54 study participants (12.6%), ID without anaemia in 72 patients (16.8%), whereas in 208 patients neither anaemia nor ID was present (48.9%). CS patients with anaemia without ID were older (73 ± 10 years, p = 0.001), had more frequently a history of arterial hypertension (72.8%, p = 0.01), diabetes mellitus (47.8%, p = 0.001), as well as chronic kidney disease (14.1%, p = 0.004) compared to CS patients in other groups. Anaemic CS patients without ID presence were at higher risk to develop a composite from all‐cause death or renal replacement therapy at 30‐day follow‐up (odds ratio [OR] 3.83, 95% confidence interval [CI] 2.23–6.62, p < 0.001) than CS patients without anaemia/ID. The presence of ID in CS patients, with and without concomitant anaemia, did not increase the risk for the primary outcome (OR 1.17, 95% CI 0.64–2.13, p = 0.64; and OR 1.01, 95% CI 0.59–1.73, p = 0.54; respectively) within 30 days of follow‐up. In time‐to‐event Kaplan–Meier analysis, anaemic CS patients without ID had a significantly higher hazard ratio (HR) for the primary outcome (HR 2.11, 95% CI 1.52–2.89, p < 0.001), as well as for death from any cause (HR 1.90, 95% CI 1.36–2.65, p < 0.001) and renal replacement therapy during 30‐day follow‐up (HR 2.99, 95% CI 1.69–5.31, p < 0.001).ConclusionConcomitant anaemia without ID presence in patients with CS at hospital presentation is associated with higher risk for death from any cause or renal replacement therapy and the individual components of this composite endpoint within 30 days after hospitalization. ID has no relevant impact on clinical outcomes in patients with CS.

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Extracorporeal Membrane Oxygenation in Infarct-Related Cardiogenic Shock

Cited by 7 publications

References 68 publications

Venoarterial extracorporeal membrane oxygenation in acute myocardial infarction

Venoarterial extracorporeal membrane oxygenation in acute myocardial infarction

Extracorporeal Life Support in Myocardial Infarction: New Highlights

Impact of anaemia and iron deficiency on outcomes in cardiogenic shock complicating acute myocardial infarction

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