Extracorporeal life support in cardiogenic shock: exploring before liberalizing

Abstract

Cardiogenic shock (CS) is the leading cause of death after acute myocardial infarction (AMI), affecting up to 10% of the patients. Despite all the recent advances, CS is invariably associated with mortality rates around 40-50%. Interestingly, some reports even describe a recent increase in the probability of developing CS after AMI and in the mortality rates, probably due to ageing of population and increased risk profiles. When general intensive care measures are insufficient, mechanical circulatory support is an option, with extracorporeal membrane oxygenation (ECMO) being one of the most popular options nowadays. The development of miniaturized systems and percutaneous cannulations have widened the use of ECMO. Although initial trials observed a significant increase of survival in CS with the use of ECMO, the evidence for its use in CS is scarce, and limited to observational studies and three small randomized trials.