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The impact of extracorporeal membrane oxygenation on mortality in patients with cardiogenic shock post-acute myocardial infarction: a systematic review and meta-analysis

Published version
Peer-reviewed

Repository DOI


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Authors

Meng, James 
Johnson, Nicholas 
Chattopadhyay, Rahul 
Tsampasian, Vasiliki 

Abstract

jats:titleAbstract</jats:title> jats:sec jats:titleAims</jats:title> jats:pCardiogenic shock remains the leading cause of death in patients hospitalized with acute myocardial infarction. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used in the treatment of infarct-related cardiogenic shock. However, there is limited evidence regarding its beneficial impact on mortality. The aim of this study was to systematically review studies reporting the impact of VA-ECMO on mortality in patients with acute myocardial infarction complicated by cardiogenic shock.</jats:p> </jats:sec> jats:sec jats:titleMethods and results</jats:title> jats:pA comprehensive search of medical databases (Cochrane Register and PubMed) was conducted. Studies that reported mortality outcomes in patients treated with VA-ECMO for infarct-related cardiogenic shock were included. The database search yielded 1194 results, of which 11 studies were included in the systematic review. Four of these studies, with a total of 586 patients, were randomized controlled trials and were included in the meta-analysis. This demonstrated that there was no significant difference in 30-day all-cause mortality with the use of VA-ECMO compared with standard medical therapy [odds ratio (OR) 0.91; 95% confidence interval (CI) 0.65–1.27]. Meta-analysis of two studies showed that VA-ECMO was associated with a significant reduction in 12-month all-cause mortality (OR 0.31; 95% CI 0.11–0.86). Qualitative synthesis of the observational studies showed that age, serum creatinine, serum lactate, and successful revascularization are independent predictors of mortality.</jats:p> </jats:sec> jats:sec jats:titleConclusion</jats:title> jats:pVeno-arterial extracorporeal membrane oxygenation does not improve 30-day all-cause mortality in patients with cardiogenic shock following acute myocardial infarction; however, there may be significant reduction in all-cause mortality at 12 months. Further studies are needed to delineate the potential benefit of VA-ECMO in long-term outcomes.</jats:p> </jats:sec> jats:sec jats:titleRegistration</jats:title> jats:pThe protocol was registered in the PROSPERO International Prospective Register of Systematic Reviews (ID: CRD42023461740).</jats:p> </jats:sec>

Description

Funder: NIHR; DOI: https://doi.org/10.13039/501100000272


Funder: Academic Clinical Fellows


Funder: Wellcome Trust PhD Fellowship

Keywords

32 Biomedical and Clinical Sciences, 3202 Clinical Sciences, 42 Health Sciences, Heart Disease - Coronary Heart Disease, Heart Disease, Cardiovascular, Clinical Research, Clinical Trials and Supportive Activities, Cardiovascular, 3 Good Health and Well Being

Journal Title

European Heart Journal Open

Conference Name

Journal ISSN

2752-4191
2752-4191

Volume Title

4

Publisher

Oxford University Press (OUP)