Routine Early ECLS in Infarct-Related Cardiogenic Shock?

This NEJM editorial critiques the ECLS-SHOCK trial, which evaluated whether early use of extracorporeal life support (ECLS) improves outcomes in infarct-related cardiogenic shock. In 417 patients randomized to immediate ECLS or medical therapy alone after coronary angiography, 30-day mortality was similar (47.8% vs. 49.0%; RR 0.98; P = 0.81). ECLS patients required longer mechanical ventilation and ICU stays and had more bleeding and limb ischemia, but no clear benefit in myocardial recovery, neurologic outcomes, or revascularization rates. While the trial enrolled high-risk individuals (median lactate 6.9 mmol/L; median EF 30%; 78% with pre-randomization CPR), subgroup analyses showed consistent lack of benefit. Authors stress selective rather than routine ECLS use, highlighting its potential risks (increased afterload, renal injury, stroke), and call for further studies to better identify patients who may benefit from early ECLS.

This NEJM editorial critiques the ECLS-SHOCK trial, which evaluated whether early use of extracorporeal life support (ECLS) improves outcomes in infarct-related cardiogenic shock. In 417 patients randomized to immediate ECLS or medical therapy alone after coronary angiography, 30-day mortality was similar (47.8% vs. 49.0%; RR 0.98; P = 0.81). ECLS patients required longer mechanical ventilation and ICU stays and had more bleeding and limb ischemia, but no clear benefit in myocardial recovery, neurologic outcomes, or revascularization rates. While the trial enrolled high-risk individuals (median lactate 6.9 mmol/L; median EF 30%; 78% with pre-randomization CPR), subgroup analyses showed consistent lack of benefit. Authors stress selective rather than routine ECLS use, highlighting its potential risks (increased afterload, renal injury, stroke), and call for further studies to better identify patients who may benefit from early ECLS.