Summary
This multicentre randomised controlled trial evaluated early extracorporeal life support (ECLS) plus standard medical treatment versus standard medical treatment alone in 417 patients with acute myocardial infarction complicated by cardiogenic shock. The study found no mortality benefit from ECLS at 30 days (47.8% vs 49.0%; relative risk 0.98), whilst ECLS was associated with significantly increased rates of moderate or severe bleeding (23.4% vs 9.6%) and peripheral vascular complications (11.0% vs 3.8%).
UK applicability
This multinational trial (likely including German and European centres based on author affiliations) provides evidence directly relevant to UK cardiology practice and NICE guidance regarding ECLS use in cardiogenic shock, suggesting routine early ECLS does not improve survival and increases serious bleeding risk.
Key measures
30-day all-cause mortality (primary outcome); relative risk of death (ECLS vs. control); duration of mechanical ventilation (median days); moderate or severe bleeding (percentage of patients); peripheral vascular complications warranting intervention (percentage of patients)
Outcomes reported
The study measured 30-day all-cause mortality as the primary outcome, and safety outcomes including bleeding, stroke, and peripheral vascular complications. Early extracorporeal life support (ECLS) plus usual medical treatment was compared to usual medical treatment alone in patients with acute myocardial infarction complicated by cardiogenic shock.
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