High mortality from heart failure despite mechanical cardiovascular support

Cardiogenic shock is triggered by a pumping failure of the heart and often by a heart attack. The heart is then no longer able to maintain circulation. After an acute heart attack with cardiogenic shock, there is an almost 50 per cent risk of death within 30 days. For over ten years, patients have often been treated with venoarterial extracorporeal membrane oxygenation, or VA-ECMO or ECLS for short. This mechanical circulatory support involves the use of systems that help the diseased heart to pump blood through the body. A VA-ECMO can theoretically take over the function of the heart and lungs for a certain period of time. However, this form of therapy also leads to possible complications such as bleeding or leg ischaemia, a sudden interruption of the blood supply in the leg due to the large channels used. Holger Thiele, Director of the University Clinic for Cardiology at Leipzig Heart Centre, HELIOS Endowed Professor at Leipzig University and President of the German Society of Cardiology, has now conducted a large clinical study involving a total of 420 patients at 44 centres in Germany and Slovenia. In patients with acute myocardial infarction and subsequent cardiogenic shock, VA-ECMO therapy plus drug therapy in the intensive care unit was compared with drug therapy in the intensive care unit alone. In contrast to standard therapy, mortality was not statistically significantly different at 47.8 per cent versus 49 per cent. The VA-ECMO group even had more complications such as severe haemorrhage or leg ischaemia. We therefore need to rethink our approach and reduce the bleeding induced by the mechanical systems as well as the additional inflammatory stimulus. Presumably, less is more in cardiogenic shock“, explains Prof Thiele the main results of the study. The results were also confirmed by a patient-based meta-analysis that compared the results of all four previous studies on mechanical cardiovascular support with VA-ECMO versus control therapy. Here, too, there was no survival benefit from VA-ECMO with more complications.

„The study results show that we need to reduce the frequency of treatment with VA-ECMOs in Germany and internationally. The future guidelines will certainly take this up soon and downgrade the recommendation for therapy with active mechanical cardiovascular support systems or even generally no longer recommend it in routine treatment," says Prof Thiele. The heart specialist is still planning many follow-up studies, including a one-year follow-up to recognise any differences over time. „It remains our goal to reduce the very high mortality rate in cardiogenic shock. We can only show this through innovative studies“, says Prof. Thiele.  

Prof. Dr Holger Thiele has been Director of the University Clinic for Cardiology – HELIOS Endowed Professorship at the Leipzig Heart Centre since 2017. In addition to his clinical work at the Leipzig Heart Centre, Professor Thiele and his team are closely involved in research and teaching at Leipzig University's Faculty of Medicine as part of the HELIOS endowed professorship.

Press release by "idw - Informationsdienst Wissenschaft" from 28 August 2023