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The New England Journal of MedicineExtracorporeal Life Support in Infarct-Related Cardiogenic Shock

A Question of Mortality Benefit

In a recent multicenter trial, researchers sought to determine the impact of extracorporeal life support (ECLS) on mortality rates in patients with acute myocardial infarction complicated by cardiogenic shock. The study’s findings challenge the increasing use of ECLS in such cases, revealing no significant reduction in 30-day mortality compared to standard medical treatment.

HCN Medical Memo
This study suggests that adding ECLS to your treatment regimen may not offer a mortality benefit over standard medical therapy alone. Moreover, ECLS was associated with increased risks of bleeding and peripheral vascular complications, warranting careful consideration before its application.

Study Design:
  • Multicenter trial involving 420 randomized patients, with 417 included in the final analyses.
  • Patients had acute myocardial infarction complicated by cardiogenic shock and were planned for early revascularization.
  • Participants were divided into two groups: one receiving early ECLS plus usual medical treatment (ECLS group) and the other receiving usual medical treatment alone (control group).
  • Primary outcome was death from any cause at 30 days.
  • Safety outcomes included bleeding, stroke, and peripheral vascular complications requiring intervention.

Approximately 5-8% of acute myocardial infarction cases are complicated by cardiogenic shock, making it a critical area of study.

Key Findings:
  • 30-day mortality was 47.8% in the ECLS group and 49.0% in the control group (RR 0.98, 95% CI 0.80 to 1.19, P=0.81).
  • Median duration of mechanical ventilation was 7 days in the ECLS group and 5 days in the control group.
  • Moderate or severe bleeding occurred in 23.4% of the ECLS group and 9.6% of the control group (RR 2.44, 95% CI 1.50 to 3.95).
  • Peripheral vascular complications requiring intervention were 11.0% in the ECLS group and 3.8% in the control group (RR 2.86, 95% CI 1.31 to 6.25).

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