What does this research mean for the field?

VA-ECMO support in ACS-induced cardiogenic shock yields a 44.7% hospital discharge survival rate but is associated with high complication rates, including bleeding and acute kidney injury. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

March 3, 2026

42: Outcomes of Venoarterial ECMO in Acute Coronary Syndrome with Cardiogenic Shock: A Single - Center Retrospective Study (2021–2025)

Key Result

VA-ECMO support in ACS-induced cardiogenic shock had a 44.7% hospital discharge survival rate but was associated with high complication rates.

Key Points

VA-ECMO support resulted in a hospital discharge survival rate of 44.7%, highlighting significant mortality risk.
Among 38 patients, complications included acute kidney injury requiring renal replacement therapy in 42.1%, highlighting serious risks.
Retrospective analysis of patients receiving VA-ECMO between January 2021 and June 2025, providing valuable clinical insights.
Early initiation of VA-ECMO correlates with successful weaning; optimization in patient selection may improve outcomes.

Structured PICO

Population

38 patients with ACS-induced cardiogenic shock (refractory shock following myocardial infarction despite maximal inotropic support and revascularization), mean age 56 years, 89% male.

Intervention

Venoarterial Extracorporeal Membrane Oxygenation (VA-ECMO) support for a duration of 2 to 10 days (mean 3.8 ± 1.8 days).

Outcome

Survival to hospital dischargehard clinical

In patients with ACS-induced cardiogenic shock, VA-ECMO provided a 44.7% survival rate to hospital discharge but was associated with significant morbidity including high rates of AKI and bleeding.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Background: Acute coronary syndrome (ACS) complicated by cardiogenic shock carries a high mortality despite advances in revascularization and critical care. Veno Arterial Extracorporeal membrane oxygenation (VA-ECMO) has emerged as a rescue therapy providing temporary circulatory and respiratory support. This study reviews outcomes and complications of VA ECMO in patients with ACS‑related cardiogenic shock in a single tertiary‑care center. Methods: A retrospective analysis was conducted in 38 patients with ACS‑induced cardiogenic shock who received VA-ECMO support between January 2021 and June 2025. Demographic data with mean age, clinical outcomes and complications were collected from institutional records. Descriptive statistics were used to summarize the findings. Results: The mean age was 56 years, with a majority of males (89%). All patients presented with refractory shock following myocardial infarction despite maximal inotropic support and revascularization. 38 patients were instituted VA‑ECMO, of which 17 (44.7%) survived to hospital discharge, while 21 (55.3%) died during hospitalization. Major ECMO‑related complications included bleeding requiring transfusion in 14 cases (36.8%), limb ischemia in 5 (13.6%), stroke in 2 (5.3%), acute kidney injury requiring renal replacement therapy in 16 (42.1%), and sepsis in 8 (21%). Duration of ECMO support ranged from 2 to 10 days (mean 3.8 ± 1.8days). Successful weaning correlated with early initiation and absence of severe end‑organ dysfunction prior to cannulation. Conclusion: In patients with ACS‑related cardiogenic shock, VA-ECMO offers a valuable bridge to recovery or decision but remains associated with significant morbidity and mortality. Optimization of patient selection, early initiation, and vigilant monitoring for complications are essential to improve outcomes. Larger multicenter prospective studies are needed to validate these findings and refine ECMO protocols in the context of ACS.

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