Zeymer Uwe, Westermann Dirk
Department of Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Freiburg.
Institut für Herzinfarktforschung, Ludwigshafen, Germany.
Curr Opin Crit Care. 2025 Aug 1;31(4):473-479. doi: 10.1097/MCC.0000000000001295. Epub 2025 Jun 12.
Despite improvements in reperfusion and adjunctive therapies cardiogenic shock associated with acute myocardial infarction is still associated with a mortality of 40-50%. Therefore, mechanical circulatory support devices are increasingly used. One option is veno-arterial extracorporal membrane oxygenation (VA-ECMO). VA-ECMO can be implanted percutaneously and blood is actively pumped into a tubing system outside the body which also incorporates an artificial lung for oxygenation and removal of carbon dioxide and then sent back retrograde in the aorta. This review summarizes the current evidence for the use of VA-ECMO in cardiogenic shock.
Four randomized clinical trials including the large ECLS-SHOCK trial with 417 patients and two individual patient data meta-analyses did not show any mortality benefit with the routine use of VA-ECMO, but a consistent increase in bleeding and peripheral vascular ischemic complications. So far, patients with STEMI and a low likelihood of brain injury might be an attractive group for the use of VA-ECMO. In addition patients in need for oxygenation might benefit from VA-ECMO.
The results of the ECLS-SHOCK trial and the meta-analyses call for a conservative approach regarding a routine unselected use of early VA-ECMO in patients with infarct-related cardiogenic shock.
尽管再灌注治疗和辅助治疗有所改进，但与急性心肌梗死相关的心源性休克死亡率仍为40%-50%。因此，机械循环支持设备的使用越来越多。一种选择是静脉-动脉体外膜肺氧合（VA-ECMO）。VA-ECMO可经皮植入，血液被主动泵入体外的管路系统，该系统还包含一个人工肺用于氧合和清除二氧化碳，然后逆行送回主动脉。本综述总结了VA-ECMO用于心源性休克的当前证据。
四项随机临床试验，包括有417例患者的大型ECLS-SHOCK试验以及两项个体患者数据荟萃分析，均未显示常规使用VA-ECMO有任何死亡率获益，但出血和外周血管缺血并发症持续增加。到目前为止，ST段抬高型心肌梗死且脑损伤可能性低的患者可能是使用VA-ECMO的有吸引力的群体。此外，需要氧合的患者可能从VA-ECMO中获益。
ECLS-SHOCK试验和荟萃分析的结果呼吁对梗死相关心源性休克患者常规非选择性早期使用VA-ECMO采取保守方法。
