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Extracorporeal Life Support in Infarct-Related Cardiogenic Shock

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Extracorporeal Life Support in Infarct-Related Cardiogenic Shock. / Thiele, Holger; Zeymer, Uwe; Akin, Ibrahim; Behnes, Michael; Rassaf, Tienush; Mahabadi, Amir Abbas; Lehmann, Ralf; Eitel, Ingo; Graf, Tobias; Seidler, Tim; Schuster, Andreas; Skurk, Carsten; Duerschmied, Daniel; Clemmensen, Peter; Hennersdorf, Marcus; Fichtlscherer, Stephan; Voigt, Ingo; Seyfarth, Melchior; John, Stefan; Ewen, Sebastian; Linke, Axel; Tigges, Eike; Nordbeck, Peter; Bruch, Leonhard; Jung, Christian; Franz, Jutta; Lauten, Philipp; Goslar, Tomaz; Feistritzer, Hans-Josef; Pöss, Janine; Kirchhof, Eva; Ouarrak, Taoufik; Schneider, Steffen; Desch, Steffen; Freund, Anne; ECLS-SHOCK Investigators.

In: NEW ENGL J MED, Vol. 389, No. 14, 05.10.2023, p. 1286-1297.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Thiele, H, Zeymer, U, Akin, I, Behnes, M, Rassaf, T, Mahabadi, AA, Lehmann, R, Eitel, I, Graf, T, Seidler, T, Schuster, A, Skurk, C, Duerschmied, D, Clemmensen, P, Hennersdorf, M, Fichtlscherer, S, Voigt, I, Seyfarth, M, John, S, Ewen, S, Linke, A, Tigges, E, Nordbeck, P, Bruch, L, Jung, C, Franz, J, Lauten, P, Goslar, T, Feistritzer, H-J, Pöss, J, Kirchhof, E, Ouarrak, T, Schneider, S, Desch, S, Freund, A & ECLS-SHOCK Investigators 2023, 'Extracorporeal Life Support in Infarct-Related Cardiogenic Shock', NEW ENGL J MED, vol. 389, no. 14, pp. 1286-1297. https://doi.org/10.1056/NEJMoa2307227

APA

Thiele, H., Zeymer, U., Akin, I., Behnes, M., Rassaf, T., Mahabadi, A. A., Lehmann, R., Eitel, I., Graf, T., Seidler, T., Schuster, A., Skurk, C., Duerschmied, D., Clemmensen, P., Hennersdorf, M., Fichtlscherer, S., Voigt, I., Seyfarth, M., John, S., ... ECLS-SHOCK Investigators (2023). Extracorporeal Life Support in Infarct-Related Cardiogenic Shock. NEW ENGL J MED, 389(14), 1286-1297. https://doi.org/10.1056/NEJMoa2307227

Vancouver

Thiele H, Zeymer U, Akin I, Behnes M, Rassaf T, Mahabadi AA et al. Extracorporeal Life Support in Infarct-Related Cardiogenic Shock. NEW ENGL J MED. 2023 Oct 5;389(14):1286-1297. https://doi.org/10.1056/NEJMoa2307227

Bibtex

@article{87b08347ca6348519f5764062202851b,
title = "Extracorporeal Life Support in Infarct-Related Cardiogenic Shock",
abstract = "BACKGROUND: Extracorporeal life support (ECLS) is increasingly used in the treatment of infarct-related cardiogenic shock despite a lack of evidence regarding its effect on mortality.METHODS: In this multicenter trial, patients with acute myocardial infarction complicated by cardiogenic shock for whom early revascularization was planned were randomly assigned to receive early ECLS plus usual medical treatment (ECLS group) or usual medical treatment alone (control group). The primary outcome was death from any cause at 30 days. Safety outcomes included bleeding, stroke, and peripheral vascular complications warranting interventional or surgical therapy.RESULTS: A total of 420 patients underwent randomization, and 417 patients were included in final analyses. At 30 days, death from any cause had occurred in 100 of 209 patients (47.8%) in the ECLS group and in 102 of 208 patients (49.0%) in the control group (relative risk, 0.98; 95% confidence interval [CI], 0.80 to 1.19; P = 0.81). The median duration of mechanical ventilation was 7 days (interquartile range, 4 to 12) in the ECLS group and 5 days (interquartile range, 3 to 9) in the control group (median difference, 1 day; 95% CI, 0 to 2). The safety outcome consisting of moderate or severe bleeding occurred in 23.4% of the patients in the ECLS group and in 9.6% of those in the control group (relative risk, 2.44; 95% CI, 1.50 to 3.95); peripheral vascular complications warranting intervention occurred in 11.0% and 3.8%, respectively (relative risk, 2.86; 95% CI, 1.31 to 6.25).CONCLUSIONS: In patients with acute myocardial infarction complicated by cardiogenic shock with planned early revascularization, the risk of death from any cause at the 30-day follow-up was not lower among the patients who received ECLS therapy than among those who received medical therapy alone. (Funded by the Else Kr{\"o}ner Fresenius Foundation and others; ECLS-SHOCK ClinicalTrials.gov number, NCT03637205.).",
keywords = "Humans, Extracorporeal Membrane Oxygenation/adverse effects, Myocardial Infarction/complications, Retrospective Studies, Risk, Shock, Cardiogenic/etiology, Treatment Outcome, Myocardial Revascularization",
author = "Holger Thiele and Uwe Zeymer and Ibrahim Akin and Michael Behnes and Tienush Rassaf and Mahabadi, {Amir Abbas} and Ralf Lehmann and Ingo Eitel and Tobias Graf and Tim Seidler and Andreas Schuster and Carsten Skurk and Daniel Duerschmied and Peter Clemmensen and Marcus Hennersdorf and Stephan Fichtlscherer and Ingo Voigt and Melchior Seyfarth and Stefan John and Sebastian Ewen and Axel Linke and Eike Tigges and Peter Nordbeck and Leonhard Bruch and Christian Jung and Jutta Franz and Philipp Lauten and Tomaz Goslar and Hans-Josef Feistritzer and Janine P{\"o}ss and Eva Kirchhof and Taoufik Ouarrak and Steffen Schneider and Steffen Desch and Anne Freund and {ECLS-SHOCK Investigators}",
note = "Copyright {\textcopyright} 2023 Massachusetts Medical Society.",
year = "2023",
month = oct,
day = "5",
doi = "10.1056/NEJMoa2307227",
language = "English",
volume = "389",
pages = "1286--1297",
journal = "NEW ENGL J MED",
issn = "0028-4793",
publisher = "Massachussetts Medical Society",
number = "14",

}

RIS

TY - JOUR

T1 - Extracorporeal Life Support in Infarct-Related Cardiogenic Shock

AU - Thiele, Holger

AU - Zeymer, Uwe

AU - Akin, Ibrahim

AU - Behnes, Michael

AU - Rassaf, Tienush

AU - Mahabadi, Amir Abbas

AU - Lehmann, Ralf

AU - Eitel, Ingo

AU - Graf, Tobias

AU - Seidler, Tim

AU - Schuster, Andreas

AU - Skurk, Carsten

AU - Duerschmied, Daniel

AU - Clemmensen, Peter

AU - Hennersdorf, Marcus

AU - Fichtlscherer, Stephan

AU - Voigt, Ingo

AU - Seyfarth, Melchior

AU - John, Stefan

AU - Ewen, Sebastian

AU - Linke, Axel

AU - Tigges, Eike

AU - Nordbeck, Peter

AU - Bruch, Leonhard

AU - Jung, Christian

AU - Franz, Jutta

AU - Lauten, Philipp

AU - Goslar, Tomaz

AU - Feistritzer, Hans-Josef

AU - Pöss, Janine

AU - Kirchhof, Eva

AU - Ouarrak, Taoufik

AU - Schneider, Steffen

AU - Desch, Steffen

AU - Freund, Anne

AU - ECLS-SHOCK Investigators

N1 - Copyright © 2023 Massachusetts Medical Society.

PY - 2023/10/5

Y1 - 2023/10/5

N2 - BACKGROUND: Extracorporeal life support (ECLS) is increasingly used in the treatment of infarct-related cardiogenic shock despite a lack of evidence regarding its effect on mortality.METHODS: In this multicenter trial, patients with acute myocardial infarction complicated by cardiogenic shock for whom early revascularization was planned were randomly assigned to receive early ECLS plus usual medical treatment (ECLS group) or usual medical treatment alone (control group). The primary outcome was death from any cause at 30 days. Safety outcomes included bleeding, stroke, and peripheral vascular complications warranting interventional or surgical therapy.RESULTS: A total of 420 patients underwent randomization, and 417 patients were included in final analyses. At 30 days, death from any cause had occurred in 100 of 209 patients (47.8%) in the ECLS group and in 102 of 208 patients (49.0%) in the control group (relative risk, 0.98; 95% confidence interval [CI], 0.80 to 1.19; P = 0.81). The median duration of mechanical ventilation was 7 days (interquartile range, 4 to 12) in the ECLS group and 5 days (interquartile range, 3 to 9) in the control group (median difference, 1 day; 95% CI, 0 to 2). The safety outcome consisting of moderate or severe bleeding occurred in 23.4% of the patients in the ECLS group and in 9.6% of those in the control group (relative risk, 2.44; 95% CI, 1.50 to 3.95); peripheral vascular complications warranting intervention occurred in 11.0% and 3.8%, respectively (relative risk, 2.86; 95% CI, 1.31 to 6.25).CONCLUSIONS: In patients with acute myocardial infarction complicated by cardiogenic shock with planned early revascularization, the risk of death from any cause at the 30-day follow-up was not lower among the patients who received ECLS therapy than among those who received medical therapy alone. (Funded by the Else Kröner Fresenius Foundation and others; ECLS-SHOCK ClinicalTrials.gov number, NCT03637205.).

AB - BACKGROUND: Extracorporeal life support (ECLS) is increasingly used in the treatment of infarct-related cardiogenic shock despite a lack of evidence regarding its effect on mortality.METHODS: In this multicenter trial, patients with acute myocardial infarction complicated by cardiogenic shock for whom early revascularization was planned were randomly assigned to receive early ECLS plus usual medical treatment (ECLS group) or usual medical treatment alone (control group). The primary outcome was death from any cause at 30 days. Safety outcomes included bleeding, stroke, and peripheral vascular complications warranting interventional or surgical therapy.RESULTS: A total of 420 patients underwent randomization, and 417 patients were included in final analyses. At 30 days, death from any cause had occurred in 100 of 209 patients (47.8%) in the ECLS group and in 102 of 208 patients (49.0%) in the control group (relative risk, 0.98; 95% confidence interval [CI], 0.80 to 1.19; P = 0.81). The median duration of mechanical ventilation was 7 days (interquartile range, 4 to 12) in the ECLS group and 5 days (interquartile range, 3 to 9) in the control group (median difference, 1 day; 95% CI, 0 to 2). The safety outcome consisting of moderate or severe bleeding occurred in 23.4% of the patients in the ECLS group and in 9.6% of those in the control group (relative risk, 2.44; 95% CI, 1.50 to 3.95); peripheral vascular complications warranting intervention occurred in 11.0% and 3.8%, respectively (relative risk, 2.86; 95% CI, 1.31 to 6.25).CONCLUSIONS: In patients with acute myocardial infarction complicated by cardiogenic shock with planned early revascularization, the risk of death from any cause at the 30-day follow-up was not lower among the patients who received ECLS therapy than among those who received medical therapy alone. (Funded by the Else Kröner Fresenius Foundation and others; ECLS-SHOCK ClinicalTrials.gov number, NCT03637205.).

KW - Humans

KW - Extracorporeal Membrane Oxygenation/adverse effects

KW - Myocardial Infarction/complications

KW - Retrospective Studies

KW - Risk

KW - Shock, Cardiogenic/etiology

KW - Treatment Outcome

KW - Myocardial Revascularization

U2 - 10.1056/NEJMoa2307227

DO - 10.1056/NEJMoa2307227

M3 - SCORING: Journal article

C2 - 37634145

VL - 389

SP - 1286

EP - 1297

JO - NEW ENGL J MED

JF - NEW ENGL J MED

SN - 0028-4793

IS - 14

ER -