Do DAN-GER-SHOCK eligible patients benefit from VA-ECMO treatment in infarct-related cardiogenic shock ? Results of an individual patient data meta-analysis.

Abstract Background In a recent meta-analysis of randomized controlled trials routine use of venous-arterial ECMO (VA-ECMO) did not improve outcome in patients with infarct related cardiogenic shock (CS). Since the rate of patients with cardiac arrest and the need for cardio-pulmonary resuscitation was over 75 %, it has been speculated that a more selective approach might improve the effectiveness of VA-ECMO. Methods Patients included in four randomized clinical trials investigating the routine use of VA-ECMO in CS were centrally analysed. For the purpose of this sub-analysis only patients who would have been eligible for inclusion into the Dan-Ger SHOCK trial were analyzed (STEMI only, exclusion of comatose patients after out-of hospital cardiac arrest). The primary endpoint was 180-day total mortality. Results A total of 202 patients (106 randomised to VA-ECMO and 96 to control) were included into this analysis. There were no differences in baseline characteristics, angiographic and interventional features between the two groups. The table summarizes the results and revealed non-significant trends towards a reduced mortality with VA-ECMO. Conclusions In non-comatose patients with CS and STEMI the routine use of VA-ECMO is associated with a numerically lower mortality after 6 months. However, as indicated by the large confidence intervals the statistical power was limited, to draw definite conclusions. Therefore, a prospective trial with VA-ECMO in these patients seems warranted.Table