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

Abstract

Abstract Background 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. Methods 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. 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). Conclusion ECMO did not improve clinical outcomes compared to the standard of care in patients with CS-MI but increased the bleeding risk.

Keywords

• ECMO
• Cardiogenic shock
• Myocardial infarction
• Mortality
• Reinfarction