Best to reserve early ECMO for patients with MI-related shock more likely to benefit than be harmed, but ''we need further studies to tell us who they are,' experts say.
Almost half of the trial's patients died, whether or not they had been put on ECMO. All-cause mortality at 30 days, the primary endpoint, was about the same, at 47.8% and 49.0% for the ECMO and usual-care groups, respectively.
For example, there were no significant differences for the primary outcome by age, sex, whether the MI was ST-segment elevation MI or non–ST-segment elevation MI or anterior or nonanterior, or whether the patient had diabetes. "Will the results of the ECLS-SHOCK trial change current clinical practice? If the goal of [ECMO] is to improve 30-day mortality, these data should steer interventional and critical care cardiologists away from its early routine implementation for all or even most patients with"There will be some patients in this population for whom [ECMO] is necessary and lifesaving, but the results of the ECLS-SHOCK trial do not tell us which ones," write Jane A.
Given that ECMO increases afterload,"which is physiologically detrimental in patients with an ongoing MI, one is left to wonder if the results would have been different with greater use of LV unloading," said Bangalore, of Langone Health and NYU School of Medicine, New York City, who isn't associated with ECLS-SHOCK.cardiopulmonary resuscitation
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