11, 1
Control (usual care, with rescue ECMO available in the constituent trials)
Early VA ECMO
IPD meta-analysis of trials sharing a common design weakness (crossover). Constituent trials not identified in the source read. READ VIA SECONDARY SUMMARY (ACC journal scan) because Lancet and ScienceDirect are inaccessible from this environment; volume, pages and DOI unverified.
Patients with infarct-related cardiogenic shock pooled from four randomised trials: 284 allocated to VA ECMO, 283 to control. The four constituent trials are NOT named in the summary read for this entry.
30-day all-cause mortality
OR 0.93 (95% CI 0.66 to 1.29) - no significant reduction. Prespecified subgroup analyses consistent and showing no benefit in any subgroup (p for interaction 0.079 or greater). HARMS: major bleeding OR 2.44 (95% CI 1.55 to 3.84); peripheral ischaemic vascular complications OR 3.53 (95% CI 1.70 to 7.34). Authors' conclusion: 'These data do not justify unselected use of VA-ECMO in patients with cardiogenic shock.'
Confined to infarct-related shock. Inherits the crossover problem of its constituent trials, so it still compares strategies rather than device against nothing. Subgroup analyses were prespecified but the population was too homogeneous to test substrate-based selection - myocarditis, poisoning and PE are simply absent from the pooled dataset.
Pooling individual patient data across the randomised evidence confirms no mortality signal for early VA ECMO in infarct-related cardiogenic shock, and quantifies the harm: roughly 2.4-fold major bleeding and 3.5-fold peripheral vascular complications. The absence of ANY positive subgroup is the strongest single argument against unselected use.