Methodology: 4/5
Usefulness: 1/5
Thiele H, et al. Lancet. 2024 Sep 14;404(10457):1019-1028. doi: 10.1016/S0140-6736(24)01448-X
Question and Methods: Does routine early use of mechanical circulatory support (MCS) reduce mortality in acute myocardial infarction cardiogenic shock (AMICS) compared to standard medical therapy?
Findings: AMICS mortality was between 45-55% regardless of MCS vs. usual care, however STEMI-related cardiogenic shock with a low risk of hypoxic brain injury did show benefit from MCS.
Limitations: Standard AMICS medical therapy was not consistent over the 20 years in this metaanalysis, and more than one type of MCS was included (ECMO & Impella).
Interpretation: The emergency physician’s role is rapid recognition & stabilization of AMICS, and the decision to use MCS is made by cardiologists, so this changes little about our EM practice.
JC Supervisor: Dr. Ian Stiell
