Cardiology in critical care · Mechanical support in cardiogenic shock
Extracorporeal Membrane Oxygenation in the Therapy of Cardiogenic Shock
| Design | Multicentre randomised clinical trial |
|---|---|
| Treatment | Immediate veno-arterial ECMO |
| Control | Early conservative strategy permitting downstream ECMO |
| Population | 117 analysed patients with rapidly deteriorating or severe cardiogenic shock |
| Follow-up | 30 days |
| Primary endpoint | Composite of death from any cause, resuscitated circulatory arrest, and another mechanical circulatory support device at 30 days |
| Result | 58 patients were randomised to immediate veno-arterial ECMO and 59 to no immediate ECMO. Immediate implementation did not improve clinical outcomes compared with the conservative strategy. |
| Secondary endpoints | All-cause mortality, serious adverse events |
Immediate implementation of VA-ECMO in patients with rapidly deteriorating or severe cardiogenic shock did not improve clinical outcomes compared with an early conservative strategy that permitted downstream use of VA-ECMO.
The trial authors, in the published abstract
Structurally identical to EOLIA in respiratory failure: immediate versus rescue deployment, with crossover permitted. It tests timing rather than the therapy itself, and finds no advantage to going early.
Ostadal P, Rokyta R, Karasek J, et al. Extracorporeal Membrane Oxygenation in the Therapy of Cardiogenic Shock: Results of the ECMO-CS Randomized Clinical Trial. Circulation 2023 Feb 7;147(6):454-464.