The impact of extracorporeal membrane oxygenation on mortality in patients with cardiogenic shock post acute myocardial infarction: a systematic review and meta-analysis

Cardiogenic shock remains the leading cause of death in patients hospitalised with acute myocardial infarction. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used in the treatment of infarct-related cardiogenic shock. However, there is limited evidence regarding its beneficial impact on mortality. To systematically review studies reporting the impact of VA-ECMO on mortality in patients with acute myocardial infarction complicated by cardiogenic shock. Comprehensive search of medical databases (Cochrane Register, PubMed) was conducted. Studies that reported mortality outcomes in patients treated with VA-ECMO for infarct-related cardiogenic shock were included. The database search yielded 1194 results, of which 11 studies were included in the systematic review. Four of these studies, with a total of 586 patients, were randomised-controlled trials and were included in the meta-analysis. This demonstrated that there was no significant difference in 30-day all-cause mortality with the use of VA-ECMO compared to standard medical therapy (OR 0.91; 95% confidence interval (CI) 0.65-1.27). Meta-analysis of two studies showed that VA-ECMO was associated with a significant reduction in 12-month all-cause mortality (OR 0.31, CI 0.11-0.86). Qualitative synthesis of the observational studies showed that age, serum creatinine, serum lactate and successful revascularisation are independent predictors of mortality. VA-ECMO does not improve 30-day all-cause mortality in patients with cardiogenic shock following acute myocardial infarction, however there may be significant reduction in all-cause mortality at 12 months. Further studies are needed to delineate the potential benefit of VA-ECMO in long-term outcomes. The protocol was registered in the PROSPERO International Prospective Register of Systematic Reviews (ID: CRD42023461740).