1, 11, 17
Optimal medical therapy without routine early VA ECMO
Early VA ECMO
Four trials, 284 VA-ECMO and 283 control patients; all open-label; restricted to infarct-related shock.
Pooled individual patient data from randomised trials of early VA ECMO in infarct-related cardiogenic shock
All-cause death at 30 days
OR 0.93 (95% CI 0.66-1.29); no benefit in any prespecified subgroup (p for interaction >=0.079). Major bleeding OR 2.44 (1.55-3.84); peripheral ischaemic vascular complications OR 3.53 (1.70-7.34).
It cannot identify a responder subgroup that was not represented in the constituent trials, and it does not address rescue use or non-infarct phenotypes.
At individual patient data level there is no mortality signal for routine early VA ECMO in infarct-related cardiogenic shock, and a consistent harm signal for bleeding and limb ischaemia.