Efficacy and safety of extracorporeal membrane oxygenation for cardiogenic shock complicating myocardial infarction: a systematic review and meta-analysis

• Published in: BMC cardiovascular disorders Vol. 24; no. 1; pp. 362 - 13
• Main Authors: Elsaeidy, Ahmed Saad, Taha, Amira Mohamed, Abuelazm, Mohamed, Soliman, Youssef, Ali, Mohamed Ahmed, Alassiri, Abdullah K, Shaikhkhalil, Hosam, Abdelazeem, Basel
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 16-07-2024; BioMed Central; BMC
• Subjects: Aged; Bias; Bleeding; Blood oxygenation, Extracorporeal; Blood pressure; Cardiogenic shock; Care and treatment; Cerebral infarction; Clinical trials; Complications and side effects; Decision making; Diagnosis; ECMO; Extracorporeal membrane oxygenation; Extracorporeal Membrane Oxygenation - adverse effects; Extracorporeal Membrane Oxygenation - mortality; Female; Handbooks; Heart attack; Heart attacks; Hospital patients; Humans; Hypertension; Male; Meta-analysis; Middle Aged; Mortality; Myocardial infarction; Myocardial Infarction - complications; Myocardial Infarction - diagnosis; Myocardial Infarction - mortality; Myocardial Infarction - therapy; Oxygenation; Patient outcomes; Randomized Controlled Trials as Topic; Reinfarction; Risk Assessment; Risk Factors; Sepsis; Shock, Cardiogenic - diagnosis; Shock, Cardiogenic - etiology; Shock, Cardiogenic - mortality; Shock, Cardiogenic - physiopathology; Shock, Cardiogenic - therapy; Systematic Review; Time Factors; Treatment Outcome; Weaning; Egypt; ECMO; Myocardial infarction; Cardiogenic shock; Mortality; Reinfarction
• ISSN: 1471-2261; 1471-2261
• DOI: 10.1186/s12872-024-03917-9

Extracorporeal membrane oxygenation (ECMO) has been presented as a potential therapeutic option for patients with cardiogenic shock complicating myocardial infarction (CS-MI). We aimed to investigate the efficacy and safety of ECMO in CS-MI.
A systematic review and meta-analysis synthesizing evidence from randomized controlled trials obtained from PubMed, Embase, Cochrane, Scopus, and Web of Science until September 2023. We used the random-effects model to report dichotomous outcomes using risk ratio and continuous outcomes using mean difference with a 95% confidence interval. Finally, we implemented a trial sequential analysis to evaluate the reliability of our results.
We included four trials with 611 patients. No significant difference was observed between ECMO and standard care groups in 30-day mortality with pooled RR of 0.96 (95% CI: 0.81-1.13, p = 0.60), acute kidney injury (RR: 0.65, 95% CI: 0.41-1.03, p = 0.07), stroke (RR: 1.16, 95% CI: 0.38-3.57, p = 0.80), sepsis (RR: 1.06, 95% CI: 0.77-1.47, p = 0.71), pneumonia (RR: 0.99, 95% CI: 0.58-1.68, p = 0.96), and 30-day reinfarction (RR: 0.95, 95% CI: 0.25-3.60, p = 0.94). However, the ECMO group had higher bleeding events (RR: 2.07, 95% CI: 1.44-2.97, p < 0.0001).
ECMO did not improve clinical outcomes compared to the standard of care in patients with CS-MI but increased the bleeding risk.