Impacto do ECMO na mortalidade do choque cardiogénico por enfarte agudo do miocárdio: uma revisão

Abstract

Introduction: Cardiogenic shock is a state of hypoperfusion due to cardiac failure. Its main etiology is acute myocardial infarction. Despite therapeutic advances, mortality in these patients remains high. The aim of this review is to analyze the impact of ECMO on mortality of patients with cardiogenic shock due to myocardial infarction. Materials and methods: A literature search was conducted in Medline (PubMed) and ISI Web of Science, using the following query: "ECMO" AND "acute myocardial infarction" AND "cardiogenic shock". 733 results were obtained, and 27 full-text articles were included, from 1999 to 2020. Results: The in-hospital survival rates registered great variability, ranging from 18.3% to 67.0%, with a mean value of 40.7%. A few non-randomized studies have found higher survival rates when comparing ECMO and non-ECMO treatment. Complications associated with ECMO were frequent, particularly vascular complications (19.8%). Several studies identified factors with a statistically significant association with mortality. Discussion: The variability of the survival rates could be justified by the diversity of populations and criteria for ECMO use between studies. Prevention and early recognition of complications associated with ECMO are key as they can have an impact on mortality. Conclusion: The results of the included studies are promising but randomized clinical trials and multicentric prospective studies are needed to better evaluate the impact of ECMO in cardiogenic shock due to acute myocardial infarction refractory to conventional therapy.