Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) use for cardiogenic shock (CS) is increasing worldwide despite conflicting results from randomized trials, which focused on myocardial-infarction related CS (MI-CS).

We performed a retrospective analysis of the Cardiogenic Shock Working Group (CSWG) multicenter registry to assess outcomes in CS in those supported with VA-ECMO. Continuous variables were presented as mean±SD or median+IQR for normal/non-normal distributions. Group comparisons used the t-test or Mann-Whitney U test for normal/non-normal data and chi-square test for proportions.

Between 2019 and 2023, 1728 out of 11244 CS patients (15.3%) received VA-ECMO. Median age was 58 years, and 69.9% were male. Etiologies of shock were heart failure (HF-CS: 45%), myocardial infarction (MI-CS; 34%), and other-CS (22%). Mortality was 51% and higher for MI-CS (60% vs 42%, MI vs HF-CS, p<0.01). Heart replacement therapy was more common among HF-CS patients (24% vs. 7%, HF vs MI-CS, p<0.01); 71% and 43% of HF- and MI-CS underwent cardiac transplantation. VA-ECMO was placed in a non-OR site in 74% of patients, predominantly with peripheral cannulation (71%). Distal perfusion catheters were used in 34% of VA-ECMO cases. In 71% of patients >1 MCS device was used during hospitalization. Complications included acute limb ischemia (ALI: 14% overall, 10% vs. 17%, HF vs MI-CS, p<0.01), bleeding (53% overall, 47% vs. 56%, HF vs MI-CS, p<0.01), and stroke (13% overall, 10% vs. 16%, HF vs MI-CS, p<0.01).

Using a large contemporary real-world CS registry, we report high mortality and complication rates with VA-ECMO and further identified significant differences in outcomes between MI- and HF-CS. These findings may inform clinical practice, novel device development and future shock trial designs.