1, 11, 14
Early conservative strategy with ECMO permitted as rescue
Immediate VA ECMO
Small; 23/59 (39%) of the conservative arm received downstream VA ECMO, of whom 52% died. Composite endpoint includes MCS escalation, which favours the immediate-ECMO arm by construction.
Rapidly deteriorating or severe cardiogenic shock, SCAI stage D-E
Composite of death from any cause, resuscitated circulatory arrest, or implementation of another mechanical circulatory support at 30 days
63.8% (37/58) vs 71.2% (42/59); risk difference -7.4% (95% CI -24.3 to 9.5)
It is not powered for mortality and does not address non-infarct phenotypes or the timing of rescue cannulation.
An immediate VA ECMO strategy did not improve a 30-day composite outcome compared with early conservative management with rescue ECMO available.