PMID- 36335478
OWN - NLM
STAT- MEDLINE
DCOM- 20230208
LR  - 20230915
IS  - 1524-4539 (Electronic)
IS  - 0009-7322 (Linking)
VI  - 147
IP  - 6
DP  - 2023 Feb 7
TI  - Extracorporeal Membrane Oxygenation in the Therapy of Cardiogenic Shock: Results 
      of the ECMO-CS Randomized Clinical Trial.
PG  - 454-464
LID - 10.1161/CIRCULATIONAHA.122.062949 [doi]
AB  - BACKGROUND: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is 
      increasingly being used for circulatory support in patients with cardiogenic 
      shock, although the evidence supporting its use in this context remains 
      insufficient. The ECMO-CS trial (Extracorporeal Membrane Oxygenation in the 
      Therapy of Cardiogenic Shock) aimed to compare immediate implementation of 
      VA-ECMO versus an initially conservative therapy (allowing downstream use of 
      VA-ECMO) in patients with rapidly deteriorating or severe cardiogenic shock. 
      METHODS: This multicenter, randomized, investigator-initiated, academic clinical 
      trial included patients with either rapidly deteriorating or severe cardiogenic 
      shock. Patients were randomly assigned to immediate VA-ECMO or no immediate 
      VA-ECMO. Other diagnostic and therapeutic procedures were performed as per 
      current standards of care. In the early conservative group, VA-ECMO could be used 
      downstream in case of worsening hemodynamic status. The primary end point was the 
      composite of death from any cause, resuscitated circulatory arrest, and 
      implementation of another mechanical circulatory support device at 30 days. 
      RESULTS: A total of 122 patients were randomized; after excluding 5 patients 
      because of the absence of informed consent, 117 subjects were included in the 
      analysis, of whom 58 were randomized to immediate VA-ECMO and 59 to no immediate 
      VA-ECMO. The composite primary end point occurred in 37 (63.8%) and 42 (71.2%) 
      patients in the immediate VA-ECMO and the no early VA-ECMO groups, respectively 
      (hazard ratio, 0.72 [95% CI, 0.46-1.12]; P=0.21). VA-ECMO was used in 23 (39%) of 
      no early VA-ECMO patients. The 30-day incidence of resuscitated cardiac arrest 
      (10.3.% versus 13.6%; risk difference, -3.2 [95% CI, -15.0 to 8.5]), all-cause 
      mortality (50.0% versus 47.5%; risk difference, 2.5 [95% CI, -15.6 to 20.7]), 
      serious adverse events (60.3% versus 61.0%; risk difference, -0.7 [95% CI, -18.4 
      to 17.0]), sepsis, pneumonia, stroke, leg ischemia, and bleeding was not 
      statistically different between the immediate VA-ECMO and the no immediate 
      VA-ECMO groups. CONCLUSIONS: Immediate implementation of VA-ECMO in patients with 
      rapidly deteriorating or severe cardiogenic shock did not improve clinical 
      outcomes compared with an early conservative strategy that permitted downstream 
      use of VA-ECMO in case of worsening hemodynamic status. REGISTRATION: URL: 
      https://www. CLINICALTRIALS: gov; Unique identifier: NCT02301819.
FAU - Ostadal, Petr
AU  - Ostadal P
AUID- ORCID: 0000-0001-9550-222X
AD  - Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic (P.O., 
      A.K., D.V., M.J., J.N.).
FAU - Rokyta, Richard
AU  - Rokyta R
AD  - Department of Cardiology, University Hospital and Faculty of Medicine Pilsen, 
      Charles University, Pilsen, Czech Republic (R.R., M. Hromadka, S.V., M. 
      Seyfrydova).
FAU - Karasek, Jiri
AU  - Karasek J
AD  - Hospital Liberec, Liberec, Czech Republic (J.K.).
AD  - 2nd Department of Medicine-Department of Cardiovascular Medicine, First Faculty 
      of Medicine, Charles University and General University Hospital, Prague, Liberec, 
      Czech Republic (J.K., J.S., M. Hubatova, A.L., J.B.).
FAU - Kruger, Andreas
AU  - Kruger A
AD  - Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic (P.O., 
      A.K., D.V., M.J., J.N.).
FAU - Vondrakova, Dagmar
AU  - Vondrakova D
AD  - Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic (P.O., 
      A.K., D.V., M.J., J.N.).
FAU - Janotka, Marek
AU  - Janotka M
AD  - Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic (P.O., 
      A.K., D.V., M.J., J.N.).
FAU - Naar, Jan
AU  - Naar J
AUID- ORCID: 0000-0002-7630-7039
AD  - Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic (P.O., 
      A.K., D.V., M.J., J.N.).
FAU - Smalcova, Jana
AU  - Smalcova J
AUID- ORCID: 0000-0002-4418-7984
AD  - 2nd Department of Medicine-Department of Cardiovascular Medicine, First Faculty 
      of Medicine, Charles University and General University Hospital, Prague, Liberec, 
      Czech Republic (J.K., J.S., M. Hubatova, A.L., J.B.).
FAU - Hubatova, Marketa
AU  - Hubatova M
AD  - 2nd Department of Medicine-Department of Cardiovascular Medicine, First Faculty 
      of Medicine, Charles University and General University Hospital, Prague, Liberec, 
      Czech Republic (J.K., J.S., M. Hubatova, A.L., J.B.).
FAU - Hromadka, Milan
AU  - Hromadka M
AD  - Department of Cardiology, University Hospital and Faculty of Medicine Pilsen, 
      Charles University, Pilsen, Czech Republic (R.R., M. Hromadka, S.V., M. 
      Seyfrydova).
FAU - Volovar, Stefan
AU  - Volovar S
AD  - Department of Cardiology, University Hospital and Faculty of Medicine Pilsen, 
      Charles University, Pilsen, Czech Republic (R.R., M. Hromadka, S.V., M. 
      Seyfrydova).
FAU - Seyfrydova, Miroslava
AU  - Seyfrydova M
AD  - Department of Cardiology, University Hospital and Faculty of Medicine Pilsen, 
      Charles University, Pilsen, Czech Republic (R.R., M. Hromadka, S.V., M. 
      Seyfrydova).
FAU - Jarkovsky, Jiri
AU  - Jarkovsky J
AD  - Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, 
      Brno, Czech Republic (J.J., M. Svoboda).
FAU - Svoboda, Michal
AU  - Svoboda M
AD  - Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, 
      Brno, Czech Republic (J.J., M. Svoboda).
AD  - Institute of Biostatistics and Analyses, Ltd, Brno, Czech Republic (M. Svoboda).
FAU - Linhart, Ales
AU  - Linhart A
AD  - 2nd Department of Medicine-Department of Cardiovascular Medicine, First Faculty 
      of Medicine, Charles University and General University Hospital, Prague, Liberec, 
      Czech Republic (J.K., J.S., M. Hubatova, A.L., J.B.).
FAU - Belohlavek, Jan
AU  - Belohlavek J
AD  - 2nd Department of Medicine-Department of Cardiovascular Medicine, First Faculty 
      of Medicine, Charles University and General University Hospital, Prague, Liberec, 
      Czech Republic (J.K., J.S., M. Hubatova, A.L., J.B.).
CN  - ECMO-CS Investigators
LA  - eng
SI  - ClinicalTrials.gov/NCT02301819
PT  - Journal Article
PT  - Multicenter Study
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
DEP - 20221106
PL  - United States
TA  - Circulation
JT  - Circulation
JID - 0147763
SB  - IM
CIN - Circulation. 2023 Feb 7;147(6):465-468. PMID: 36745696
CIN - Circulation. 2023 Aug 29;148(9):803. PMID: 37639506
CIN - Circulation. 2023 Aug 29;148(9):804. PMID: 37639508
MH  - Humans
MH  - Shock, Cardiogenic/diagnosis/therapy
MH  - *Extracorporeal Membrane Oxygenation/methods
MH  - *Heart Arrest
MH  - Hemodynamics
MH  - Hospital Mortality
MH  - Retrospective Studies
OTO - NOTNLM
OT  - clinical trial
OT  - shock, cardiogenic
OT  - therapy
EDAT- 2022/11/07 06:00
MHDA- 2023/02/09 06:00
CRDT- 2022/11/06 13:59
PHST- 2022/11/07 06:00 [pubmed]
PHST- 2023/02/09 06:00 [medline]
PHST- 2022/11/06 13:59 [entrez]
AID - 10.1161/CIRCULATIONAHA.122.062949 [doi]
PST - ppublish
SO  - Circulation. 2023 Feb 7;147(6):454-464. doi: 10.1161/CIRCULATIONAHA.122.062949. 
      Epub 2022 Nov 6.