Pulse Brain · Growing Health Evidence Index
Tier 2 — RCT / large cohortPeer-reviewed

Extracorporeal Life Support in Infarct-Related Cardiogenic Shock

Hölger Thiele, Uwe Zeymer, İbrahim Akın, Michael Behnes, Tienush Rassaf, Amir A. Mahabadi, Ralf Lehmann, Ingo Eitel, Tobias Graf, Tim Seidler, Andreas Schuster, Carsten Skurk, Daniel Duerschmied, Peter Clemmensen, Marcus Hennersdorf, Stephan Fichtlscherer, Ingo Voigt, Melchior Seyfarth, Stefan John, Sebastian Ewen, Axel Linke, Eike Tigges, Peter Nordbeck, Leonhard Bruch, Christian Jung, Jutta Franz, Philipp Lauten, Tomaž Goslar, Hans‐Josef Feistritzer, Janine Pöss, Eva Kirchhof, Taoufik Ouarrak, Steffen Schneider, Steffen Desch, Anne Freund

New England Journal of Medicine · 2023

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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.

Theme
General food systems / other
Subject
Other / interdisciplinary
Study type
Research
Study design
RCT
Source type
Peer-reviewed study
Status
Published
System type
Human clinical
DOI
10.1056/nejmoa2307227
Catalogue ID
SNmoj449kk-fuzc0f

Topic tags

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