Effects and safety of extracorporeal membrane oxygenation in the treatment of patients with ST-segment elevation myocardial infarction and cardiogenic shock: A systematic review and meta-analysis

Abstract

BackgroundThere is a lack of large randomized controlled trials (RCTs) that comprehensively evaluate the effects of venoarterial extracorporeal membrane oxygenation (V-A ECMO)- assisted treatment of patients with ST-segment elevation myocardial infarction (STEMI) combined with Cardiogenic shock (CS). This meta-analysis aims to identify predictors of short-term mortality, and the incidence of various complications in patients with STEMI and CS treated with V-A ECMO.MethodsWe searched PubMed, Cochrane Library, Web of Science, Embase, China National Knowledge Infrastructure (CNKI), and the Wanfang Database from 2008 to January 2022 for studies evaluating patients with STEMI and CS treated with V-A ECMO. Studies that reported on mortality in ≥ 10 adult (>18 years) patients were included. Newcastle-Ottawa Scale was used by two independent reviewers to assess methodological quality. Mantel-Haenszel models were used to pool the data for meta-analysis.ResultsSixteen studies (1,162 patients) were included with a pooled mortality estimate of 50.9%. Age > 65 years, BMI > 25 kg/m2, lactate > 8 mmol/L, anterior wall infarction, longer CPR time, and longer time from arrest to extracorporeal cardiopulmonary resuscitation (ECPR) were risk predictors of mortality. Achieving TIMI-3 flow after percutaneous coronary intervention (PCI) was a protective factor of mortality. The prevalence of bleeding, cerebral infarction, leg ischemia, and renal failure were 22, 9.9, 7.4, and 49.4%, respectively.ConclusionOur study identified Age, BMI, lactate, anterior wall infarction, TIMI-3 flow after PCI, CPR time, and time from arrest to ECPR significantly influence mortality in STEMI patients with CS requiring V-A ECMO. These factors may help clinicians to detect patients with poor prognoses earlier and develop new mortality prediction models.

In Patients with Cardiogenic Shock Extracorporeal Membrane Oxygenator (ECMO) Is Associated with Very High All Cause Inpatient Mortality Rate

“…Various studies have reported different mortality rates of ECMO in patients with cardiogenic shock. Overall the results have been virtually heterogenous and the in-hospital mortality rate ranged from 40% to 60 % [22][23][24][25][26][27]. Recent clinical trials comparing the efficacy of VA-ECMO and optimal medical treatment demonstrated that using ECMO in patients with cardiogenic shock did not improve early and long-term mortality [28,29].…”

In Patients with Cardiogenic Shock, Extracorporeal Membrane Oxygenation Is Associated with Very High All-Cause Inpatient Mortality Rate

“…Various studies have reported different mortality rates of ECMO in patients with cardiogenic shock. Overall, the results have been virtually heterogeneous, and the in-hospital mortality rate ranged from 40% to 60% [ 22 , 23 , 24 , 25 , 26 , 27 ]. Recent clinical trials comparing the efficacy of VA-ECMO and optimal medical treatment demonstrated that using ECMO in patients with cardiogenic shock did not improve early and long-term mortality [ 28 , 29 ].…”

Adjusted mortality of extracorporeal membrane oxygenation for acute myocardial infarction patients in cardiogenic shock

“…The IABP-SHOCK study showed that the survival of patients with MI in CS after the initial 24 hours is not associated with the cardiac index. [26] After initial shock occurred, clinical factors such as age, body mass index, lactate, anterior wall infarction, TIMI-3 flow after PCI, cardiopulmonary resuscitation time, and time from arrest to extracoporeal cardiopulmonary resiscitation may affect the clinical outcomes in MI-CS [27] ; however, the main cause of mortality during shock is multiorgan dysfunction, which is triggered by severe systemic inflammation cascade, [28] microvascular dysfunctions, and decreased perfusion to peripheral organs. [25] To prevent multiorgan dysfunction, device-related complications should be minimized during shock.…”