In patients with acute MI complicated by cardiogenic shock (AMICS) who are slated to undergo early revascularization, routine use of extracorporeal membrane oxygenation (ECMO) doesn’t reduce 30-day mortality. The negative findings, from the randomized ECLS-SHOCK trial, were released today at the European Society of Cardiology (ESC) 2023 Congress and simultaneously published in the New England Journal of Medicine.

Lead investigator Holger Thiele, MD (Heart Center Leipzig at University of Leipzig, Germany), speaking in an ESC press conference, described the lack of survival benefit as “disappointing.” He said the results will likely give clinicians—including himself—pause when deciding how best to manage this risky scenario.

After the IABP-SHOCK II trial, also led by Thiele, failed to show an advantage for use of an intra-aortic balloon pump, the field has leaned toward use of the Impella percutaneous left ventricular assist device (Abiomed) and ECMO, also known as extracorporeal life support (ECLS)—despite the absence of supportive data from large randomized trials, Thiele stressed.

In Germany and many other countries, “we have seen a tenfold increase in the use of ECMO and . . . the same for Impella,” he continued. “[This is] because we believe, as interventional cardiologists and also intensivists, that active mechanical circulatory support is able to reduce the still high 50% mortality in these patients with cardiogenic shock.”

Thiele told TCTMD that these new results should inspire introspection among clinicians. “If you ask me, ECLS-SHOCK leaves us in a situation where we have to rethink what we are doing. The steep increase in the use of mechanical circulatory support with [venoarterial] ECMO, maybe also with Impella devices, is not justified. Maybe it is too simplistic that a machine being able to provide some hemodynamic support is able to reduce mortality,” he explained in an email.