EXTRACORPOREAL MEMBRANE OXYGENATION IN THE THERAPY OF CARDIOGENIC SHOCK: ONE-YEAR OUTCOMES OF THE MULTICENTER, RANDOMIZED ECMO-CS TRIAL

Background and aims: Among patients with cardiogenic shock, immediate initiation of extracorporeal membrane oxygenation (ECMO) did not demonstrate any benefit at 30 days. The present study evaluated one-year clinical outcomes of the ECMO-CS trial.
Methods: The ECMO-CS trial randomized 117 patients with severe or rapidly progressing cardiogenic shock to: immediate initiation of ECMO or early conservative strategy. Primary endpoint for this analysis was one year all-cause mortality. Secondary endpoints included a composite of death, resuscitated cardiac arrest or implantation of another type of mechanical circulatory support, and durations of mechanical ventilation, intensive care unit (ICU) and hospital stays. In addition, an unplanned post hoc subgroup analysis was performed.
Results: At one year, all-cause death occurred in 40 of 58 (69.0%) patients in the ECMO arm and in 40 of 59 (67.8%) in the early conservative arm (HR 1.02 [95% confidence interval (CI) 0.66–1.58]; P=0.93). The composite endpoint occurred in 43 (74.1%) subjects in the ECMO group and in 47 (79.7%) in the early conservative group (hazard ratio [HR] 0.83 [95% CI 0.55–1.25]; P=0.29). The durations of mechanical ventilation, ICU stay and hospital stay were comparable between groups. Significant interaction with treatment strategy and one-year mortality was observed in subgroups according to baseline mean arterial pressure (MAP) indicating lower mortality in subgroup with low baseline MAP: Conclusions: Among patients with severe or rapidly progressing cardiogenic shock, immediate initiation of ECMO did not improve clinical outcomes at one year compared to the early conservative strategy. However, immediate ECMO initiation might be beneficial in patients with advanced hemodynamic compromise.