ECLS-SHOCK: Does Early ECLS Improve Survival in Patients With AMI and Cardiogenic Shock?

Early extracorporeal life support (ECLS) did not improve survival in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock who were scheduled for early revascularization, based on findings from the ECLS-SHOCK trial presented at ESC Congress 2023 and simultaneously published in the New England Journal of Medicine.

Researchers randomized a total of 420 patients from 44 centers in Germany and Slovenia to either early ECLS plus usual medical treatment or to usual medical treatment alone (control group). The primary endpoint was all-cause death at 30 days. Secondary endpoints included length of mechanical ventilation, time to hemodynamic stabilization and need for renal replacement therapy. Safety endpoints included moderate or severe bleeding and peripheral vascular complications requiring intervention.

Overall findings found the primary endpoint of all-cause death at 30 days occurred in 100 of 209 patients (47.8%) in the ECLS group compared with 102 of 208 patients (49.0%) in the control group. The median duration of mechanical ventilation was longer in the ECLS group at seven days, compared with five days in those receiving usual medical treatment. Additionally, researchers noted that the time to hemodynamic stabilization and rates of renal replacement therapy were similar between treatment groups, while moderate or severe bleeding occurred more frequently in the ECLS group (23.4% vs. 9.6%). Peripheral vascular complications requiring intervention also occurred more often in the ECLS group (11% vs. 3.8%).

"The results of ECLS-SHOCK demonstrated no reduction in 30-day mortality with early ECLS therapy and an increase in complications," said Holger Thiele, MD, of Leipzig Heart Centre at Leipzig University, Germany. According to Thiele, the findings challenge current guideline recommendations and clinical practice with increasing rates of mechanical circulatory support in cardiogenic shock and "may lead to the discontinued routine use of these devices in clinical practice."

In a related editorial comment, Jane A. Leopold, MD, FACC, and Darren B. Taichman, MD, PhD, note, "There will be some patients in this population for whom ECLS is necessary and lifesaving, but the results of the ECLS-SHOCK trial do not tell us which ones. For now, the best course may be to reserve the early initiation of ECLS for those patients with infarct-related cardiogenic shock in whom the likely benefits more clearly outweigh the potential harms. We need further studies to tell us who they are."

Clinical Topics: Acute Coronary Syndromes, Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: ESC Congress, ESC23, ACC International, Shock, Cardiogenic, Acute Coronary Syndrome

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