The Use of Venoarterial Extracorporeal Membrane Oxygenation in Cardiogenic Shock: a narrative review

Abstract

Abstract Cardiogenic shock (CS) develops in up to 10% of patients with acute myocardial infarction (AMI) and carries a 50% risk of mortality. Despite paucity of evidence regarding its benefit, venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used in clinical practice in patients with AMI in CS (AMI-CS). This review provides an in-depth description of the four available randomized controlled trials to date designed to evaluate the benefit of VA-ECMO in patients with AMI-CS. The lack of a mortality benefit consistent across all trials and the high rates of device-related complications raise concerns regarding current clinical practice. However, the outcome of these trials is nuanced by the limitations of each study which includes small sample sizes, challenging patient selection and high cross-over rates to the intervention group. This review emphasizes the need for designing adequately powered trials to properly assess the role of VA-ECMO in AMI-CS, in order to build evidence for best practices.