Impact of Extracorporeal Membrane Oxygenation (ECMO) in Patients with Refractory Cardiogenic Shock: Analysis of Mortality and Hemodynamic Recovery - A Systematic Review

Introduction: Extracorporeal membrane oxygenation (ECMO) is an advanced life support for critically ill patients with refractory cardiogenic shock. However, evidence on its impact on mortality, hemodynamic recovery, and complications remains heterogeneous. This review aims to systematically evaluate ECMO’s impact on mortality and hemodynamic recovery in adult patients with refractory cardiogenic shock, addressing gaps and variations in existing literature.Material and Methods: This systematic review followed PRISMA guidelines. Databases searched were PubMed, Cochrane Library, and Google Scholar. Two reviewers independently selected studies, extracted data, and assessed quality using the Newcastle–Ottawa Scale. Findings were synthesized narratively due to study heterogeneity.Results: Mortality rates ranged widely from 33 to 75%, reflecting differences in patient populations and timing of ECMO initiation. Early ECMO initiation within less than one hour of shock onset was associated with a 47 percent reduction in mortality risk. In-hospital mortality was approximately 40%, increasing to nearly 60% at one-year follow-up. Success rates for weaning patients off ECMO varied between 53% and 88%. Hemodynamic improvements following ECMO support included increased blood pressure, improved left ventricular ejection fraction, and decreased serum lactate levels. Complications were frequent and diverse, predominantly bleeding, stroke, renal failure, and limb ischemia. Bleeding complications are strongly correlated with mortality.Conclusions: ECMO provides crucial circulatory support in refractory cardiogenic shock, improving hemodynamic parameters but with persistently high mortality and complication rates. Early initiation and careful patient selection are vital for optimizing outcomes, underscoring the need for multidisciplinary management and further high-quality prospective studies.