Key result
ECMO for infarct-related cardiogenic shock linked to higher 30-day mortality than Impella, at ~69%.
Why the study?
Comparative effectiveness data for extracorporeal membrane oxygenation (ECMO) relative to other mechanical circulatory support in patients with myocardial infarction-related cardiogenic shock (MI-CS) remain limited.
Does extracorporeal membrane oxygenation (ECMO) reduce 30-day all-cause mortality compared with Impella, intra-aortic balloon pump, or medical management alone in Medicare beneficiaries hospitalized with myocardial infarction-related cardiogenic shock?
Cohort (n=102,718)
Yes
Does extracorporeal membrane oxygenation (ECMO) reduce 30-day all-cause mortality compared with Impella, intra-aortic balloon pump, or medical management alone in Medicare beneficiaries hospitalized with myocardial infarction-related cardiogenic shock?
In a contemporary Medicare cohort of patients with myocardial infarction-related cardiogenic shock, ECMO utilization remained low (1.1%) and was associated with high 30-day mortality (68%-70% in adjusted analyses), though valid causal inferences regarding survival could not be established.
Urges caution with ECMO in cardiogenic shock; leaves open confounding and adjusted comparisons in observational data.
Background Extracorporeal membrane oxygenation (ECMO) provides bi‐ventricular support for patients with myocardial infarction–related cardiogenic shock (MI‐CS); comparative effectiveness data relative to other mechanical circulatory support remain limited. We characterize contemporary ECMO utilization for MI‐CS and compare short‐term mortality across ECMO and non‐ECMO treatment strategies. Methods We compared baseline characteristics and temporal trends in mechanical circulatory support utilization among Medicare beneficiaries hospitalized with MI‐CS from 2016 to 2023 and treated with ECMO, Impella, intra‐aortic balloon pump, or medical management alone. Patient outcomes for each group were evaluated using inverse probability of treatment weighting, G‐formula approach, and grace period analysis. The primary endpoint was 30‐day all‐cause mortality. Results The cohort included 102 718 patients: 1165 (1.1%) treated with ECMO, 10 064 (9.8%) Impella, 24 631 (24.0%) intra‐aortic balloon pump, and 66 858 (65.1%) medical management alone. From 2016 to 2023, ECMO use for MI‐CS increased from 0.8% to 1.8%. The percentage of hospitals using ECMO increased from 9.2% to 17.1%. Unadjusted 30‐day mortality was higher for ECMO (69%) compared with Impella (60%), intra‐aortic balloon pump (39%), and medical management (46%) (all P <0.0001). Adjusted inverse probability of treatment weighting and G‐formula analyses revealed a 30‐day mortality rate of 68%–70% for ECMO, which was higher than that for other therapies. The grace period analysis revealed similar mortality between patients treated with ECMO (54%) and Impella (54%). Conclusions ECMO use in a contemporary Medicare cohort of patients with MI‐CS was infrequent (1.1%) and associated with high 30‐day mortality. Despite use of complementary causal inference methods, we were unable to establish valid causal inferences on ECMO use and patient survival.
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Kochar et al. (2026) conducted a cohort in Myocardial infarction–related cardiogenic shock (MI-CS) (n=102,718). Extracorporeal membrane oxygenation (ECMO) vs. Impella, intra-aortic balloon pump, or medical management alone was evaluated on 30-day all-cause mortality (p=<0.0001). ECMO for MI-related cardiogenic shock had higher unadjusted 30-day mortality (69%) than Impella (60%), IABP (39%), or medical therapy (46%; all P<0.0001), though grace period mortality matched Impella (54%).
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