42: Outcomes of Venoarterial ECMO in Acute Coronary Syndrome with Cardiogenic Shock: A Single - Center Retrospective Study (2021–2025)

Background: Acute coronary syndrome (ACS) complicated by cardiogenic shock carries a high mortality despite advances in revascularization and critical care. Veno Arterial Extracorporeal membrane oxygenation (VA-ECMO) has emerged as a rescue therapy providing temporary circulatory and respiratory support. This study reviews outcomes and complications of VA ECMO in patients with ACS‑related cardiogenic shock in a single tertiary‑care center. Methods: A retrospective analysis was conducted in 38 patients with ACS‑induced cardiogenic shock who received VA-ECMO support between January 2021 and June 2025. Demographic data with mean age, clinical outcomes and complications were collected from institutional records. Descriptive statistics were used to summarize the findings. Results: The mean age was 56 years, with a majority of males (89%). All patients presented with refractory shock following myocardial infarction despite maximal inotropic support and revascularization. 38 patients were instituted VA‑ECMO, of which 17 (44.7%) survived to hospital discharge, while 21 (55.3%) died during hospitalization. Major ECMO‑related complications included bleeding requiring transfusion in 14 cases (36.8%), limb ischemia in 5 (13.6%), stroke in 2 (5.3%), acute kidney injury requiring renal replacement therapy in 16 (42.1%), and sepsis in 8 (21%). Duration of ECMO support ranged from 2 to 10 days (mean 3.8 ± 1.8days). Successful weaning correlated with early initiation and absence of severe end‑organ dysfunction prior to cannulation. Conclusion: In patients with ACS‑related cardiogenic shock, VA-ECMO offers a valuable bridge to recovery or decision but remains associated with significant morbidity and mortality. Optimization of patient selection, early initiation, and vigilant monitoring for complications are essential to improve outcomes. Larger multicenter prospective studies are needed to validate these findings and refine ECMO protocols in the context of ACS.