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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
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ECMO and Short-term Support for Cardiogenic Shock in Heart Failure.
Mathew Jose Chakaramakkil1, Cumaraswamy Sivathasan2
1Department of Cardiothoracic Surgery, Level 12, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore. mathew.jose.c@singhealth.com.sg.
Current Cardiology Reports
|August 18, 2018
Summary
Extracorporeal membrane oxygenation (ECMO) significantly improves 30-day survival in cardiogenic shock patients compared to intra-aortic balloon pump (IABP). ECMO is recommended for refractory cases and specific severe conditions.
Area of Science:
- Cardiology
- Critical Care Medicine
- Mechanical Circulatory Support
Background:
- Intra-aortic balloon pump (IABP) and percutaneous ventricular assist devices (e.g., Impella, TandemHeart) have shown limited survival benefits in cardiogenic shock.
- Previous trials like "IMPRESS in severe shock" found no survival difference between Impella CP and IABP.
Purpose of the Study:
- To review the role and efficacy of Extracorporeal Membrane Oxygenation (ECMO) in managing cardiogenic shock.
- To evaluate ECMO's effectiveness compared to other mechanical circulatory support (MCS) devices.
Main Methods:
- Review of existing clinical trials and meta-analyses comparing different MCS strategies for cardiogenic shock.
- Analysis of cohort studies evaluating ECMO versus IABP in cardiogenic shock patients.
Main Results:
- A meta-analysis demonstrated a 33% improvement in 30-day survival with ECMO compared to IABP (NNT 3).
- ECMO is indicated for medically refractory cardiogenic shock, especially with an estimated mortality >50%.
Conclusions:
- ECMO is a preferred MCS option for cardiogenic shock, particularly in cases of biventricular failure, respiratory failure, life-threatening arrhythmias, or cardiac arrest.
- ECMO offers a significant survival advantage in severe cardiogenic shock unresponsive to conventional therapies.
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