Extracorporeal Life Support in Myocardial Infarction: New Highlights
Abstract
:1. Background
2. VA-ECMO: Indications, Positioning and Management
3. New Updates and Highlights about the Role of VA-ECMO in CS
3.1. EURO-SHOCK Trial
3.2. ECMO-CS Trial
3.3. ECLS-SHOCK Trial
4. The Role of Left Ventricular Unloading Systems during ECLS
Left Ventricular Unloading with Impella during VA-ECMO: HOW and WHEN to WEAN
5. Discussion and Conclusions
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- Anchor trial (NCT04184635) (started in October 2021). The study is designed to examine whether the combination of VA-ECMO support and IABP results in improved clinical outcomes when compared to medical treatment alone in patients with AMI and CS;
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- Recover IV trial (NCT05506449) (started in October 2023) The aim of this study is to evaluate whether initiating a hemodynamic support strategy using Impella before percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) complicated by CS leads to better survival and functional outcomes when compared to a treatment strategy without Impella.
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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When to consider VA-ECMO: |
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Example of inclusion criteria for ECPR: |
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Authors | Year of Randomization | Type of Study | Patient Population | Primary Endpoint | Group | Size | LV unloading Management | 30 Day—Mortality |
---|---|---|---|---|---|---|---|---|
Brunner S. et al. [20] | 2019 | monocentric, open-label, randomized controlled | CS complicating AMI * | To assess the effect of VA-ECMO on 30-day mortality | ECLS group | 21 | not reported | 19% in the ECLS group and 33% in the control group. (p = 0.37) |
no-ECLS group | 21 | |||||||
Banning A.S. et al. (EURO-SHOCK trial) [22] | January 2020—January 2022 | multicentric, open-label, randomized controlled | CS complicating AMI ** | To assess the effect of VA-ECMO on 30-day mortality | ECLS group | 17 | IABP in all VA-ECMO patients | 43.8% in the ECLS group and 61.1% in the control group. (p = 0.22) |
no-ECLS group | 18 | |||||||
Ostadal P. et al. (ECMO-CS trial) [23] | September 2014—January 2022 | multicentric, open-label, randomized controlled | all non-surgical causes of CS *** | To compare the immediate implementation of VA-ECMO with early conservative therapy | immediate ECMO | 58 | LV unloading at the discretion of the physician | 50% in the immediate ECMO and 47.5% in the early conservative group. |
early conservative therapy | 59 | |||||||
Thiele H. et al. (ECLS-SHOCK trial) [24] | June 219—November 2022 | multicentric, open-label, randomized controlled | CS complicating AMI **** | To assess the early addition of ECLS to early revascularization | ECLS group | 211 | Unloading rate in ECLS group 5.8% | 47.8% in the ECLS group and 49.0% in the control group (p = 0.81). |
no-ECLS group | 209 |
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Piccone, G.; Schiavoni, L.; Mattei, A.; Benedetto, M. Extracorporeal Life Support in Myocardial Infarction: New Highlights. Medicina 2024, 60, 907. https://doi.org/10.3390/medicina60060907
Piccone G, Schiavoni L, Mattei A, Benedetto M. Extracorporeal Life Support in Myocardial Infarction: New Highlights. Medicina. 2024; 60(6):907. https://doi.org/10.3390/medicina60060907
Chicago/Turabian StylePiccone, Giulia, Lorenzo Schiavoni, Alessia Mattei, and Maria Benedetto. 2024. "Extracorporeal Life Support in Myocardial Infarction: New Highlights" Medicina 60, no. 6: 907. https://doi.org/10.3390/medicina60060907