Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used in patients with cardiogenic shock despite the lack of evidence from adequately powered randomised clinical trials. Three trials reported so far were underpowered to detect a survival benefit; we therefore conducted an individual patient-based meta-analysis to assess the effect of VA-ECMO on 30-day death rate. Randomised clinical trials comparing early routine use of VA-ECMO versus optimal medical therapy alone in patients presenting with infarct-related cardiogenic shock were identified by searching MEDLINE, Cochrane Central Register of Controlled Trials, Embase, and trial registries until June 12, 2023. Trials were included if at least all-cause death rate 30 days after in-hospital randomisation was reported and trial investigators agreed to collaborate (ie, providing individual patient data). Odds ratios (ORs) as primary outcome measure were pooled using logistic regression models. This study is registered with PROSPERO (CRD42023431258). Four trials (n=567 patients; 284 VA-ECMO, 283 control) were identified and included. Overall, there was no significant reduction of 30-day death rate with the early use of VA-ECMO (OR 0·93; 95% CI 0·66–1·29). Complication rates were higher with VA-ECMO for major bleeding (OR 2·44; 95% CI 1·55–3·84) and peripheral ischaemic vascular complications (OR 3·53; 95% CI 1·70–7·34). Prespecified subgroup analyses were consistent and did not show any benefit for VA-ECMO (p ≥0·079). VA-ECMO did not reduce 30-day death rate compared with medical therapy alone in patients with infarct-related cardiogenic shock, and an increase in major bleeding and vascular complications was observed. A careful review of the indication for VA-ECMO in this setting is warranted. Foundation Institut für Herzinfarktforschung.

中文翻译：

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梗塞相关心源性休克患者的静脉动脉体外膜氧合：随机试验的个体患者数据荟萃分析

尽管缺乏充分有力的随机临床试验证据，静脉动脉体外膜肺氧合（VA-ECMO）越来越多地用于心源性休克患者。迄今为止报告的三项试验的效力不足以检测生存益处；因此，我们进行了一项基于个体患者的荟萃分析，以评估 VA-ECMO 对 30 天死亡率的影响。通过搜索 MEDLINE、Cochrane 对照试验中心注册库、Embase 和截至 2023 年 6 月 12 日的试验注册中心，确定了对梗塞相关心源性休克患者的早期常规使用 VA-ECMO 与单独最佳药物治疗进行比较的随机临床试验。如果至少报告了院内随机分组后 30 天的全因死亡率，并且试验研究人员同意合作（即提供个体患者数据），则纳入。使用逻辑回归模型汇总优势比（OR）作为主要结果指标。本研究已在 PROSPERO 注册（CRD42023431258）。确定并纳入了四项试验（n=567 名患者；284 名 VA-ECMO，283 名对照）。总体而言，早期使用 VA-ECMO 并没有显着降低 30 天死亡率（OR 0·93；95% CI 0·66–1·29）。VA-ECMO 大出血（OR 2·44；95% CI 1·55–3·84）和外周缺血性血管并发症（OR 3·53；95% CI 1·70–7·34）的并发症发生率较高。预先指定的亚组分析是一致的，并且没有显示 VA-ECMO 具有任何益处 (p ≥0·079)。与单纯药物治疗相比，VA-ECMO 并未降低梗死相关心源性休克患者的 30 天死亡率，并且观察到大出血和血管并发症有所增加。有必要仔细审查 VA-ECMO 在这种情况下的适应症。Herzinfarktforschung 基金会研究所。