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Ann Thorac Surg. 2019 Jun 5. pii: S0003-4975(19)30727-1. doi: 10.1016/j.athoracsur.2019.04.049. [Epub ahead of print]

Extracorporeal life support in myocardial infarction-induced cardiogenic shock: Weaning success.

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Department of Cardiac Surgery, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, AUSTRIA.
Department of Cardiology, Innsbruck Medical University.
Department of Medical Statistics, Informatics and Health Economics, Innsbruck Medical University.
Department of Anaesthesiology and Intensive Care Medicine, Innsbruck Medical University.
Department of Cardiac Surgery, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, AUSTRIA. Electronic address:



Outcome data of patients with acute myocardial infarction-induced (AMI) cardiogenic shock (CS) receiving extracorporeal life support (ECLS) are sparse.


A consecutive series of 106 patients with AMI-induced CS receiving ECLS was evaluated regarding ECLS weaning success, hospital mortality, and long-term outcome. The IABP-SHOCK II risk score was applied and multivariable Cox regression analysis was performed.


Mean patient age was 58.2 ± 11.2 years and 78.3% were male gender. In 34 patients (32.1%) ECLS was implemented during ongoing CPR. De novo AMI was present in 58 patients (54.7%), PCI complications causative among 48 patients (45.3%). Multi-vessel coronary artery disease was diagnosed among 73.6% with mean SYNTAX scores of 30.8 ± 4.8. Actuarial 30-day survival was 54.4%, 42.2% at 1 year and 38.0% at 5 years and was significantly higher among patients with low and intermediate IABP-SHOCK II risk scores at ECLS onset (log-rank: p=0.017). ECLS weaning with curative intention after a mean perfusion time of 6.6 ± 5.1 days was feasible in 51 patients (48.1%) and more likely among patients with complete revascularization (p=0.026). Multivariable Cox regression analysis identified complete revascularization (HR: 2.38; 95% CI: 1.1 - 5.1; p=0.028) and absence of relevant mitral regurgitation at ECLS discontinuation (HR: 2.71, 95% CI: 1.2 - 6.0; p=0.014) to be associated with beneficial long-term survival after ECLS discontinuation.


Emergency ECLS is a valuable option among patients with AMI-induced CS with low and intermediate IABP SHOCK II risk scores. ECLS weaning is manageable but additional revascularization of all non-culprit lesions is mandatory after ECLS implementation.


acute myocardial infarction; cardiogenic shock; extracorporeal life support; extracorporeal membrane oxygenation

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