Extracorporeal membrane oxygenation increases bleeding risk in patients with cardiogenic shock

1. 30-day mortality was comparable among patients on VA-ECMO and medical therapy alone.

2. VA-ECMO was associated with increased adverse events such as major bleeding and peripheral vascular disease-related ischemia.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used with early coronary revascularization in infarct-related cardiogenic shock. However, mixed evidence exists with mortality rates as high as 50%, according to some studies. This meta-analysis aimed to examine the utility of early VA-ECMO versus optimal medical therapy alone in patients with infarct-related cardiogenic shock. The primary outcome was the 30-day mortality rate, while a key secondary outcome was the incidence of adverse events including major bleeding and peripheral ischemic vascular complications. According to study results, early VA-ECMO did not reduce mortality compared to medical therapy alone and was associated with an increased risk of major bleeding and vascular complications. Although well-executed, this study was limited by a small sample size, thus affecting the validity of the results.

Click to read the study in The Lancet

Relevant Reading: Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome

In-depth [meta-analysis]: A total of four trials involving 567 patients (284 on VA-ECMO and 283 on medical therapy alone) were studied dating back to June 12, 2023. Included were trials that assessed the clinical efficacy of VA-ECMO and reported a 30-day all-cause mortality post-randomization. The primary outcome of 30-day mortality showed no significant reduction with early VA-ECMO versus medical therapy (46% vs. 48%, odds ratio [OR] 0.93, 95% confidence interval [CI] 0.66–1.29). VA-ECMO was also associated with a significantly increased risk of adverse events including major bleeding (OR 2.44 [1.55-3.84]) and peripheral ischemic vascular complications (OR 3.53 [1.70-7.34). Overall, findings from this study suggest that early VA-ECMO did not reduce 30-day mortality in patients with infarct-related cardiogenic shock and was associated with increased complications, warranting a reevaluation of its indication in this setting.

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