No benefit of routine V-A ECMO in patients with AMI-related cardiogenic shock (September 2023)
Venoarterial extracorporeal membrane oxygenation (V-A ECMO) can increase survival for patients with refractory cardiogenic shock caused by a variety of conditions. However, benefit from the routine use of V-A ECMO for cardiogenic shock due to acute myocardial infarction (AMI) is unproven. In a meta-analysis of four randomized trials (nearly 570 patients with AMI-related cardiogenic shock), routine V-A ECMO use showed no mortality benefit and increased rates of both major bleeding and peripheral vascular ischemia compared with medical care alone [8]. Limitations of this meta-analysis include crossover between groups and a low rate of active left ventricular uploading during ECMO therapy, which may have biased the study in favor of the control group. These findings suggest no meaningful benefit for the routine use of V-A ECMO for patients with AMI-related cardiogenic shock but does not preclude benefit in selected patients who are candidates for salvage procedures such as heart transplant. (See "Extracorporeal life support in adults: Management of venoarterial extracorporeal membrane oxygenation (V-A ECMO)", section on 'Refractory cardiogenic shock'.)
Comparison of donor hearts procured after circulatory death or brain death in heart transplantation (June 2023)
The use of donor hearts obtained after declaration of circulatory death (DCD) may increase the number of available donor hearts for transplantation, but may also increase the risk of graft dysfunction compared with donor hearts obtained after declaration of brain death (DBD). In a recent randomized trial in nearly 200 heart recipients, recipients assigned to transplantation with a DCD donor heart had similar six-month survival compared with those assigned to receive a DBD donor heart; postoperative graft dysfunction at 30 days was higher among recipients of a DCD donor heart [21]. While these results suggest comparable short-term survival among recipients of a DCD or DBD donor heart, certain issues in the trial design and analysis (such as crossover from the DCD to the DBD group and important differences in baseline characteristics between the groups) limit the interpretation of the findings. In highly selected recipients and donors, survival after heart transplantation with a DCD donor heart may be similar to that with a DBD donor heart. (See "Heart transplantation in adults: Donor selection and organ allocation", section on 'Donation after circulatory death'.)
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