ACCORDING to late-breaking research results presented at the American Heart Association’s (AHA) Scientific Sessions 2022, 5th–7th November, immediate use of venoarterial extracorporeal membrane oxygenation (ECMO) devices for cardiogenic shock did not improve clinical outcomes compared to early conservative therapy using inotropes and vasopressors.
During a press conference, Petr Ostadal, Professor of Medicine, Department of Cardiology, Na Homolce Hospital, Prague, Czechia, highlighted the relevance of studying ECMO in severe or rapidly progressing cardiac shock: “ECMO is increasingly used for circulatory support in people with cardiogenic shock or cardiac arrest, yet current evidence on the implementation of ECMO to stabilise haemodynamic conditions in these patients remains insufficient.”
The ECMO-CS trial enrolled 117 adults (average age of 65 years; approximately 75% were male) at four centres across Czechia. The patients, who either had rapidly deteriorating or severe cardiogenic shock, were randomised to two groups: ECMO or early conservative therapy.
The primary endpoint was a composite of all-cause mortality, resuscitated circulatory arrest, and implementation of another mechanical circulatory support device within 30 days of experiencing severe or rapidly progressing cardiogenic shock. The cumulative incidence was similar between immediate venoarterial ECMO and conservative therapy (64% and 71%, respectively).
Further, there was no difference between early ECMO and the conservative strategy for any of the safety endpoints, including a composite of serious adverse events such as bleeding, leg ischaemia, stroke, pneumonia, and sepsis (60% and 61%, respectively).
Interestingly, patients receiving ECMO were less likely to require another mechanical circulatory support device within 30 days when compared to those in the conservative group (17% and 42%, respectively).
Finally, 39% of patients who received initial conservative therapy required downstream ECMO later in the course of intensive care.
Summarising the findings, Ostadal noted: “We expected to see a significant improvement in outcomes for patients with severe or rapidly progressing cardiogenic shock who underwent early ECMO treatment, and we were surprised to find that immediate use of ECMO was actually not superior to early conservative therapy.”
Limitations included that the trial was not blinded and had a limited sample size. In addition, ECMO implementation was not compared with conservative therapy but rather a conservative strategy permitting bail-out ECMO therapy in instances of worsening haemodynamic status.