Bridging pathways after venoarterial extracorporeal membrane oxygenation in infarct-related cardiogenic shock: a single-center real-world cohort study

Objective Acute myocardial infarction complicated by cardiogenic shock remains highly lethal. We evaluated venoarterial extracorporeal membrane oxygenation as a time-limited bridging platform rather than as stand-alone rescue support. Methods In this single center retrospective observational cohort study, we retrospectively screened adults who received venoarterial extracorporeal membrane oxygenation for infarct-related cardiogenic shock at Linyi People's Hospital from January 2021 to December 2025. Among 498 extracorporeal membrane oxygenation procedures, 218 infarct-related cardiogenic shock cases were identified. After excluding 76 extracorporeal cardiopulmonary resuscitation cases, 142 patients were analysed. Post-support pathways were classified as recovery surrogate, cardiac surgery, heart transplantation, durable left ventricular assist device support, or bridge failure. Cardiac surgery, heart transplantation, and durable left ventricular assist device support were combined as definitive downstream bridging. Exploratory multivariable logistic regression examined early characteristics associated with recovery surrogate versus bridge failure. Results Mean age was 57.5 ± 11.5 years, and 112 patients (78.9%) were male. Mortality at 28, 90, and 365 days was 33.8%, 40.8%, and 41.5%, respectively. Recovery surrogate was reached in 68 patients (47.9%), bridge failure occurred in 53 (37.3%), heart transplantation in 14 (9.9%), cardiac surgery in 5 (3.5%), and durable left ventricular assist device support in 2 (1.4%). Overall, 21 patients (14.8%) entered definitive downstream bridging. Older age and out-of-hospital cannulation were associated with lower odds of definitive downstream bridging. Among the 121 patients without definitive downstream bridging, higher left ventricular ejection fraction, younger age and lower creatinine were associated with recovery surrogate in multivariable analysis. In exploratory adjusted survival analysis, definitive downstream bridging was associated with lower 365-day mortality. Conclusions Post-support pathways were heterogeneous. A pathway-based framework may better capture the clinical value of venoarterial extracorporeal membrane oxygenation than mortality alone.