Impact of Extracorporeal Membrane Oxygenation (ECMO) in Patients with Refractory Cardiogenic Shock: Analysis of Mortality and Hemodynamic Recovery - A Systematic Review
DOI:
https://doi.org/10.56294/saludcyt20251955Keywords:
Extracorporeal membrane oxygenation, Refractory cardiogenic shock, Mortality, Hemodynamic recovery, Complications, Systematic reviewAbstract
Introduction: Extracorporeal membrane oxygenation (ECMO) is an advanced life support for critically ill patients with refractory cardiogenic shock. However, evidence on its impact on mortality, hemodynamic recovery, and complications remains heterogeneous. This review aims to systematically evaluate ECMO’s impact on mortality and hemodynamic recovery in adult patients with refractory cardiogenic shock, addressing gaps and variations in existing literature.
Material and Methods: This systematic review followed PRISMA guidelines. Databases searched were PubMed, Cochrane Library, and Google Scholar. Two reviewers independently selected studies, extracted data, and assessed quality using the Newcastle–Ottawa Scale. Findings were synthesized narratively due to study heterogeneity.
Results: Mortality rates ranged widely from 33 to 75%, reflecting differences in patient populations and timing of ECMO initiation. Early ECMO initiation within less than one hour of shock onset was associated with a 47 percent reduction in mortality risk. In-hospital mortality was approximately 40%, increasing to nearly 60% at one-year follow-up. Success rates for weaning patients off ECMO varied between 53% and 88%. Hemodynamic improvements following ECMO support included increased blood pressure, improved left ventricular ejection fraction, and decreased serum lactate levels. Complications were frequent and diverse, predominantly bleeding, stroke, renal failure, and limb ischemia. Bleeding complications are strongly correlated with mortality.
Conclusions: ECMO provides crucial circulatory support in refractory cardiogenic shock, improving hemodynamic parameters but with persistently high mortality and complication rates. Early initiation and careful patient selection are vital for optimizing outcomes, underscoring the need for multidisciplinary management and further high-quality prospective studies.
References
1 A. Reyentovich, M. H. Barghash, and J. S. Hochman, “Management of refractory cardiogenic shock,” Nat. Rev. Cardiol., vol. 13, no. 8, pp. 481–492, Jul. 2016, doi: 10.1038/NRCARDIO.2016.96. DOI: https://doi.org/10.1038/nrcardio.2016.96
2 D. Kolte et al., “Trends in incidence, management, and outcomes of cardiogenic shock complicating ST-elevation myocardial infarction in the United States,” J. Am. Heart Assoc., vol. 3, no. 1, 2014, doi: 10.1161/JAHA.113.000590. DOI: https://doi.org/10.1161/JAHA.113.000590
3 S. Paddock, J. Meng, N. Johnson, R. Chattopadhyay, V. Tsampasian, and V. Vassiliou, “The impact of extracorporeal membrane oxygenation on mortality in patients with cardiogenic shock post-acute myocardial infarction: a systematic review and meta-analysis,” Eur. Hear. J. Open, vol. 4, no. 1, p. oeae003, Jan. 2024, doi: 10.1093/EHJOPEN/OEAE003. DOI: https://doi.org/10.1093/ehjopen/oeae003
4 J. S. Hochman et al., “Early Revascularization in Acute Myocardial Infarction Complicated by Cardiogenic Shock,” N. Engl. J. Med., vol. 341, no. 9, pp. 625–634, Aug. 1999, doi: 10.1056/NEJM199908263410901. DOI: https://doi.org/10.1056/NEJM199908263410901
5 H. Thiele, E. M., Ohman, S. De Waha-Thiele, U. Zeymer, and S. Desch, “Management of cardiogenic shock complicating myocardial infarction: An update 2019,” Eur. Heart J., vol. 40, no. 32, pp. 2671–2683, Aug. 2019, doi: 10.1093/EURHEARTJ/EHZ363. DOI: https://doi.org/10.1093/eurheartj/ehz363
6 R. A. Byrne et al., “2023 ESC Guidelines for the management of acute coronary syndromes,” Eur. Heart J., vol. 44, no. 38, pp. 3720–3826, Oct. 2023, doi: 10.1093/EURHEARTJ/EHAD191. DOI: https://doi.org/10.1093/eurheartj/ehad191
7 H. Thiele et al., “Intra-aortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock (IABP-SHOCK II): Final 12-month results of a randomised, open-label trial,” Lancet, vol. 382, no. 9905, pp. 1638–1645, 2013, doi: 10.1016/S0140-6736(13)61783-3. DOI: https://doi.org/10.1016/S0140-6736(13)61783-3
8 M. M. Meertens et al., “Meta-analysis of extracorporeal membrane oxygenation in combination with intra-aortic balloon pump vs. extracorporeal membrane oxygenation only in patients with cardiogenic shock due to acute myocardial infarction,” Front. Cardiovasc. Med., vol. 9, Jan. 2023, doi: 10.3389/FCVM.2022.1104357. DOI: https://doi.org/10.3389/fcvm.2022.1104357
9 R. J. Goldberg, F. A. Spencer, J. M. Gore, D. Lessard, and J. Yarzebski, “Thirty-year trends (1975 to 2005) in the magnitude of, management of, and hospital death rates associated with cardiogenic shock in patients with acute myocardial infarction: a population-based perspective,” Circulation, vol. 119, no. 9, pp. 1211–1219, Mar. 2009, doi: 10.1161/CIRCULATIONAHA.108.814947. DOI: https://doi.org/10.1161/CIRCULATIONAHA.108.814947
10 G. T. Sayer, J. N. Baker, and K. A. Parks, “Heart rescue: The role of mechanical circulatory support in the management of severe refractory cardiogenic shock,” Curr. Opin. Crit. Care, vol. 18, no. 5, pp. 409–416, Oct. 2012, doi: 10.1097/MCC.0B013E328357F1E6. DOI: https://doi.org/10.1097/MCC.0b013e328357f1e6
11 R. Cheng et al., “Complications of extracorporeal membrane oxygenation for treatment of cardiogenic shock and cardiac arrest: A meta-analysis of 1,866 adult patients,” Ann. Thorac. Surg..., vol. 97, no. 2, pp. 610–616, Feb. 2014, doi: 10.1016/J.ATHORACSUR.2013.09.008. DOI: https://doi.org/10.1016/j.athoracsur.2013.09.008
12 R. El Sibai, R. Bachir, and M. El Sayed, “Outcomes in cardiogenic shock patients with extracorporeal membrane oxygenation use: A matched cohort study in hospitals across the United States,” Biomed Res. Int., vol. 2018, 2018, doi: 10.1155/2018/2428648. DOI: https://doi.org/10.1155/2018/2428648
13 M. A. Zavalichi et al., “Extracorporeal Membrane Oxygenation in Cardiogenic Shock due to Acute Myocardial Infarction: A Systematic Review,” Biomed Res. Int., vol. 2020, 2020, doi: 10.1155/2020/6126534. DOI: https://doi.org/10.1155/2020/6126534
14 S. Rajsic et al., “Extracorporeal membrane oxygenation for cardiogenic shock: a meta-analysis of mortality and complications,” Ann. Intensive Care, vol. 12, no. 1, p. 93, Dec. 2022, doi: 10.1186/S13613-022-01067-9. DOI: https://doi.org/10.1186/s13613-022-01067-9
15 H. H. Lee et al., “Association Between Timing of Extracorporeal Membrane Oxygenation and Clinical Outcomes in Refractory Cardiogenic Shock,” JACC Cardiovasc. Interv., vol. 14, no. 10, pp. 1109–1119, May 2021, doi: 10.1016/J.JCIN.2021.03.048. DOI: https://doi.org/10.1016/j.jcin.2021.03.048
16 A. J. Rastan et al., “Early and late outcomes of 517 consecutive adult patients treated with extracorporeal membrane oxygenation for refractory postcardiotomy cardiogenic shock,” J. Thorac. Cardiovasc. Surg...ol. 139, no. 2, 2010, doi: 10.1016/J.JTCVS.2009.10.043. DOI: https://doi.org/10.1016/j.jtcvs.2009.10.043
17 S. Rajsic, R. Breitkopf, Z. Bukumiric, and B. Treml, “ECMO Support in Refractory Cardiogenic Shock: Risk Factors for Mortality,” J. Clin. Med..., vol. 11, no. 22, Nov. 2022, doi: 10.3390/JCM112268. DOI: https://doi.org/10.3390/jcm11226821
18 P. S. Hsu et al., “Extracorporeal membrane oxygenation for refractory cardiogenic shock after cardiac surgery: predictors of early mortality and outcome from 51 adult patients,” Eur. J. Cardio-thoracic Surg., vol. 37, no. 2, pp. 328–333, Feb. 2010, doi: 10.1016/J.EJCTS.2009.07.033,. DOI: https://doi.org/10.1016/j.ejcts.2009.07.033
19 W. Li and D. Yang, “Extracorporeal Membrane Oxygenation in Refractory Cardiogenic Shock,” Heart Surg. Forum, vol. 23, no. 6, pp. E888–E894, Nov. 2020, doi: 10.1532/HSF.3263. DOI: https://doi.org/10.1532/hsf.3263
20 M. Chonde, P. Sappington, R. Kormos, A. Althouse, and A. Boujoukos, “The Use of ECMO for the Treatment of Refractory Cardiac Arrest or Postarrest Cardiogenic Shock Following In-Hospital Cardiac Arrest: A 10-Year Experience,” J. Intensive Care Med., vol. 34, no. 8, pp. 615–621, Aug. 2019, doi: 10.1177/0885066617751398, DOI: https://doi.org/10.1177/0885066617751398
21 P. S. Elizalde et al., “Extracorporeal Membrane Oxygenation Uses in Refractory Cardiogenic Shock After Open-Heart Surgery,” Brazilian J. Cardiovasc. Surg.,. vol 39, no. 1, p. e20220344, 2023, doi: 10.21470/1678-9741-2022-0344. DOI: https://doi.org/10.21470/1678-9741-2022-0344
22 J. C. Jentzer et al., “Cardiogenic shock severity and mortality in patients receiving venovenous extracorporeal membrane oxygenator support,” Eur. Hear. Journal. Acute Cardiovasc. Care, vol. 11, no. 12, pp. 891–903, Dec. 2022, doi: 10.1093/EHJACC/ZUAC119. DOI: https://doi.org/10.1093/ehjacc/zuac119
23 J. C. Jentzer, S. G. Drakos, C. H. Selzman, C. Owyang, F. Teran, and J. E. Tonna, “Timing of Initiation of Extracorporeal Membrane Oxygenation Support and Outcomes Among Patients With Cardiogenic Shock,” J. Am. Heart Assoc., vol. 13, no. 3, 2024, doi: 10.1161/JAHA.123.032288. DOI: https://doi.org/10.1161/JAHA.123.032288
24 S. Y. Chung et al., “Outcome of patients with profound Cardiogenic shock after cardiopulmonary resuscitation and prompt extracorporeal membrane oxygenation support-a single-center observational study,” Circ. J., vol. 76, no. 6, pp. 1385–1392, Jun. 2012, doi: 10.1253/CIRCJ.CJ-11-1015,. DOI: https://doi.org/10.1253/circj.CJ-11-1015
25 T. Fux, M. Holm, M. Corbascio, L. H. Lund, and J. van der Linden, “VA-ECMO Support in Nonsurgical Patients With Refractory Cardiogenic Shock: Pre-Implant Outcome Predictors,” Artif. Organs, vol. 43, no. 2, pp. 132–141, Feb. 2019, doi: 10.1111/AOR.13331 DOI: https://doi.org/10.1111/aor.13331
26 M. R. Movahed, A. Soltani Moghadam, and M. Hashemzadeh, “In Patients with Cardiogenic Shock, Extracorporeal Membrane Oxygenation Is Associated with Very High All-Cause Inpatient Mortality Rate,” J. Clin. Med., vol. 13, no. 12, p. 3607, Jun. 2024, doi: 10.3390/JCM13123607. DOI: https://doi.org/10.3390/jcm13123607
27 J. Guihaire et al., “Clinical outcomes in patients after extracorporeal membrane oxygenation support for post-cardiotomy cardiogenic shock: a single-centre experience of 92 cases,” Interact. Cardiovasc. Thorac. Surg., vol. 25, no. 3, pp. 363–369, Sep. 2017, doi: 10.1093/ICVTS/IVX155. DOI: https://doi.org/10.1093/icvts/ivx155
28 P. Ostadal et al., “Extracorporeal Membrane Oxygenation in the Therapy of Cardiogenic Shock: Results of the ECMO-CS Randomized Clinical Trial,” Circulation, vol. 147, no. 6, pp. 454–464, Feb. 2023, doi: 10.1161/CIRCULATIONAHA.122.062949. DOI: https://doi.org/10.1161/CIRCULATIONAHA.122.062949
29 M. Pozzi, C. Payet, S. Polazzi, A. L’Hospital, J. F. Obadia, and A. Duclos, “Veno-arterial extracorporeal membrane oxygenation for cardiogenic shock after acute myocardial infarction: Insights from a French nationwide database,” Int. J. Cardiol., vol. 380, pp. 14–19, Jun. 2023, doi: 10.1016/J.IJCARD.2023.03.037. DOI: https://doi.org/10.1016/j.ijcard.2023.03.037
30 K. J. Koziol et al., “Extracorporeal Membrane Oxygenation (VA-ECMO) in Management of Cardiogenic Shock,” J. Clin. Med., vol. 12, no. 17, Sep. 2023, doi: 10.3390/JCM12175576. DOI: https://doi.org/10.3390/jcm12175576
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Copyright (c) 2025 Melina Carlos Tovar, Mitchell Walter Carbajal Alvarado, Cesar Augusto Flores Dueñas , Natalia Quintero Serrano, Luisa Alejandra Penagos Ochoa, Jessica Samantha Rea Fernández, Javier Ignacio Soto Espinoza, Mishelle Estefania Garces Lopez (Author)
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