Acute cardiac care & resuscitationSecondary analysis
Different Mechanical Circulatory Support Strategies for Infarct-Related Cardiogenic Shock
- Secondary analysis of the ECLS-SHOCK randomised trial
Authors' conclusion
Bailout and escalated MCS therapy is associated with numerically higher 30-day mortality compared with upfront ECLS use only. Bailout MCS use is also associated with higher need for renal replacement therapy.
Study context
- Population
- Patients with acute MI complicated by cardiogenic shock in the ECLS-SHOCK trial
- Participants
- 165 / 54 / 27
- Comparison
- Upfront extracorporeal life support (ECLS) only vs bailout mechanical circulatory support (MCS) vs escalated MCS therapy
- Upfront ECLSn = 165reference
- Bailout MCSn = 54
- Escalated MCSn = 27
- Primary endpoint
- All-cause mortality
- Follow-up
- 30 days
Primary result
As reported in the abstract
Further findings
| Outcome | Upfront ECLS | Bailout MCS | Escalated MCS |
|---|---|---|---|
| Need for renal replacement therapy | 7.3% (95% CI 3.8%–12.4%) | 35.2% (95% CI 22.7%–49.4%) | 14.8% (95% CI 4.2%–33.8%) |
- Need for renal replacement therapy: P < 0.001 across groups
Safety
| Outcome | Upfront ECLS | Bailout MCS | Escalated MCS |
|---|---|---|---|
| Moderate or severe bleeding complications | 25.5% (95% CI 19.0%–32.8%) | 22.2% (95% CI 12.0%–35.6%) | 22.2% (95% CI 8.6%–42.3%) |
- Moderate or severe bleeding complications: P = 0.86 across groups
Original publication
Different Mechanical Circulatory Support Strategies for Infarct-Related Cardiogenic Shock. JACC Cardiovasc Interv. Published 24 March 2025. doi:10.1016/j.jcin.2024.12.010
Summarised from the published abstract; every number is checked against it