Methodology: 4/5
Usefulness: 3.5/5

Thiele H, et al. N Engl J Med. 2023 Oct 5;389(14):1286-1297.

Editorial: Routine Early ECLS in Infarct-Related Cardiogenic Shock?

Question: Does early ECLS therapy confer a mortality benefit in patients with MI complicated by cardiogenic shock?
Methods:  Open label RCT with 417 patients comparing 30-day all-cause mortality between ECLS versus standard care therapy.
Findings: There was no significant difference in all-cause mortality between the ECLS group (47.8%) and the control group (49%). (RR 0.98; 0.8-1.19; p=0.81).
Limitations: Limitations included the lack of blinding of clinicians, as well as significant crossover between treatment arms.

Interpretation: Patients with MI complicated by cardiogenic shock do not benefit from early routine ECLS therapy; this has limited applicability in the ED setting where this decision would not be made.

By: Dr. Sara El Jaouhari

JC Supervisor: Dr. Jeff Perry