Extracorporeal Life Support in Infarct-Related Cardiogenic Shock

The ECLS-SHOCK trial investigated whether early extracorporeal life support (ECLS) improves survival in patients with acute myocardial infarction complicated by cardiogenic shock and planned early revascularization. In this multicenter, randomized study of 417 patients, 30-day mortality was similar between ECLS and control groups (47.8% vs. 49.0%; RR 0.98; P=0.81). However, ECLS was associated with significantly higher rates of moderate/severe bleeding (23.4% vs. 9.6%) and vascular complications requiring intervention (11.0% vs. 3.8%). No improvements were seen in time to hemodynamic stabilization or need for catecholamines. Despite effective coronary revascularization in both arms, the trial found no survival benefit from routine ECLS use. Authors emphasize procedural risks and the need for cautious application of ECLS in infarct-related shock, advocating further research into targeted use and adjunctive unloading strategies.

The ECLS-SHOCK trial investigated whether early extracorporeal life support (ECLS) improves survival in patients with acute myocardial infarction complicated by cardiogenic shock and planned early revascularization. In this multicenter, randomized study of 417 patients, 30-day mortality was similar between ECLS and control groups (47.8% vs. 49.0%; RR 0.98; P=0.81). However, ECLS was associated with significantly higher rates of moderate/severe bleeding (23.4% vs. 9.6%) and vascular complications requiring intervention (11.0% vs. 3.8%). No improvements were seen in time to hemodynamic stabilization or need for catecholamines. Despite effective coronary revascularization in both arms, the trial found no survival benefit from routine ECLS use. Authors emphasize procedural risks and the need for cautious application of ECLS in infarct-related shock, advocating further research into targeted use and adjunctive unloading strategies.