What’s new in VA-ECMO for acute myocardial infarction-related cardiogenic shock

Excerpt

Cardiogenic shock (CS) is a critical clinical syndrome characterized by inadequate tissue perfusion and oxygen delivery resulting from severe heart dysfunction, leading to multi-organ failure [1]. Diagnostic criteria include hypoperfusion and hypotension, with reduced cardiac index and/or elevated left ventricular filling pressures less frequently used [1, 2]. The predominant cause of CS is acute myocardial infarction (AMICS), occurring in 6–10% of AMI cases, and with persistently high mortality rates of 40–50% despite contemporary revascularization strategies. Mortality increases with more severe CS (Society for Cardiovascular Angiography and Interventions (SCAI) stage D–E) [2]. The limited success of conventional treatments has led to increased use of temporary mechanical circulatory support (tMCS) such as venoarterial extracorporeal membrane oxygenation (VA-ECMO) or the IMPELLA^® transvalvular aortic micro-axial pump [3, 4]. This trend continues despite limited high-quality evidence. tMCS augment aortic blood flow and pressure with the aim to reverse end-organ hypoperfusion and to stabilize hemodynamics, to reduce dependence on potentially harmful inotropes and vasopressors and to allow time for intervention, with the hope of improving outcomes [4]. …