Predictors of Mortality in Patients Treated with Veno-Arterial ECMO for Cardiogenic Shock Complicating Acute Myocardial Infarction: a Systematic Review and Meta-Analysis

J Cardiovasc Transl Res. 2022 Apr;15(2):227-238. doi: 10.1007/s12265-021-10140-w. Epub 2021 Jun 3.

Abstract

Background: Mortality for patients on veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for cardiogenic shock (CS) complicating acute myocardial infarction (AMI) remains high. This meta-analysis aims to identify factors that predict higher risk of mortality after VA-ECMO for AMI.

Methods: We meta-analyzed mortality after VA-ECMO for CS complicating AMI and the effect of factors from systematically selected studies published after 2009.

Results: 72 studies (10,276 patients) were included with a pooled mortality estimate of 58 %. With high confidence in estimates, failure to achieve TIMI III flow and left main culprit were identified as factors associated with higher mortality. With low-moderate confidence, older age, high BMI, renal dysfunction, increasing lactate, prothrombin activity < 50%, VA-ECMO implantation after revascularization, and non-shockable ventricular arrythmias were identified as factors associated with mortality.

Conclusion: These results provide clinicians with a framework for selecting patients for VA-ECMO for CS complicating AMI.

Keywords: Cardiogenic shock; Mortality; Myocardial infarction; VA-ECMO.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Extracorporeal Membrane Oxygenation* / adverse effects
  • Hospital Mortality
  • Humans
  • Myocardial Infarction* / complications
  • Myocardial Infarction* / therapy
  • Retrospective Studies
  • Shock, Cardiogenic / diagnosis
  • Shock, Cardiogenic / etiology
  • Shock, Cardiogenic / therapy