Effects and safety of extracorporeal membrane oxygenation in the treatment of patients with ST-segment elevation myocardial infarction and cardiogenic shock: A systematic review and meta-analysis

BACKGROUND: There is a lack of large randomized controlled trials (RCTs) that comprehensively evaluate the effects of venoarterial extracorporeal membrane oxygenation (V-A ECMO)- assisted treatment of patients with ST-segment elevation myocardial infarction (STEMI) combined with Cardiogenic shock (CS). This meta-analysis aims to identify predictors of short-term mortality, and the incidence of various complications in patients with STEMI and CS treated with V-A ECMO. METHODS: We searched PubMed, Cochrane Library, Web of Science, Embase, China National Knowledge Infrastructure (CNKI), and the Wanfang Database from 2008 to January 2022 for studies evaluating patients with STEMI and CS treated with V-A ECMO. Studies that reported on mortality in ≥ 10 adult (>18 years) patients were included. Newcastle-Ottawa Scale was used by two independent reviewers to assess methodological quality. Mantel-Haenszel models were used to pool the data for meta-analysis. RESULTS: Sixteen studies (1,162 patients) were included with a pooled mortality estimate of 50.9%. Age > 65 years, BMI > 25 kg/m(2), lactate > 8 mmol/L, anterior wall infarction, longer CPR time, and longer time from arrest to extracorporeal cardiopulmonary resuscitation (ECPR) were risk predictors of mortality. Achieving TIMI-3 flow after percutaneous coronary intervention (PCI) was a protective factor of mortality. The prevalence of bleeding, cerebral infarction, leg ischemia, and renal failure were 22, 9.9, 7.4, and 49.4%, respectively. CONCLUSION: Our study identified Age, BMI, lactate, anterior wall infarction, TIMI-3 flow after PCI, CPR time, and time from arrest to ECPR significantly influence mortality in STEMI patients with CS requiring V-A ECMO. These factors may help clinicians to detect patients with poor prognoses earlier and develop new mortality prediction models.