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ECMO and Short-term Support for Cardiogenic Shock in Heart Failure

  • Heart Failure (HJ Eisen, Section Editor)
  • Published:
Current Cardiology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

This review aims to discuss the role of ECMO in the treatment of cardiogenic shock in heart failure.

Recent Findings

Trials done previously have shown that IABP does not improve survival in cardiogenic shock compared to medical treatment, and that neither Impella 2.5 nor TandemHeart improves survival compared to IABP. The “IMPRESS in severe shock” trial compared Impella CP with IABP and found no difference in survival. A meta-analysis of cohort studies comparing ECMO with IABP showed 33% improved 30-day survival with ECMO (risk difference 33%; 95% CI 14–52%; p = 0.0008; NNT 3).

Summary

ECMO is indicated in medically refractory cardiogenic shock. ECMO can be considered in cardiogenic shock patients with estimated mortality of more than 50%. ECMO is probably the MCS of choice in cardiogenic shock with; biventricular failure, respiratory failure, life-threatening arrhythmias and cardiac arrest.

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Abbreviations

ACS:

Acute coronary syndrome

AMI:

Acute myocardial infarction

AUC:

Area under curve

BTB:

Bridge to bridge

BTD:

Bridge to decision

BTR:

Bridge to recovery

BTT:

Bridge to transplantation

CABG:

Coronary artery bypass grafting surgery

CI:

Confidence interval

CS:

Cardiogenic shock

dVAD:

Durable ventricular assist device

ECMO:

Extra corporeal membrane oxygenator

ELSO:

Extracorporeal life support organisation

ENCOURAGE:

Prediction of cardiogenic shock outcome for acute myocardial infarction patients salvaged by veno-arterial- extracorporeal membrane oxygenator

IABP:

Intra-aortic balloon pump

IMPRESS:

Impella versus intra-aortic balloon pump reduces mortality in ST-elevation myocardial infarction patients treated with primary percutaneous intervention in severe cardiogenic shock

LV:

Left ventricle

MCS:

Mechanical circulatory support

NICE:

National Institute for Health and Care Excellence

NNT:

Number needed to treat

PCI:

Percutaneous coronary intervention

PCWP:

Pulmonary capillary wedge pressure

RCT:

Randomised control trial

ROC:

Receiver operating characteristic curve

SAVE:

Survival after veno-arterial- extracorporeal membrane oxygenator, score

SHOCK:

Should we emergently revascularize occluded coronaries for cardiogenic shock

STEMI:

ST-elevation myocardial infarction

TIMI:

Thrombolysis in myocardial infarction

VA:

veno-arterial

VT:

ventricular tachycardia

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Authors and Affiliations

  1. Department of Cardiothoracic Surgery, Level 12, National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore

    Mathew Jose Chakaramakkil & Cumaraswamy Sivathasan

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  1. Mathew Jose Chakaramakkil
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Correspondence to Mathew Jose Chakaramakkil.

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Mathew Jose Chakaramakkil and Cumaraswamy Sivathasan declare that they have no conflict of interest.

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Chakaramakkil, M.J., Sivathasan, C. ECMO and Short-term Support for Cardiogenic Shock in Heart Failure. Curr Cardiol Rep 20, 87 (2018). https://doi.org/10.1007/s11886-018-1041-4

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