Predicting fast recovery in infarct-related cardiogenic shock: insights from the ECLS-SHOCK trial

In the ECLS-SHOCK (Extracorporeal Life Support in Infarct-Related Cardiogenic Shock) trial, routine ECLS did not reduce 30-day mortality in acute myocardial infarction-related cardiogenic shock (AMI-CS) but was associated with higher rates of bleeding and vascular complications.1,2 The DanGer-Shock trial compared a microaxial flow pump to control in patients with AMI-CS. In this trial, a relevant proportion of patients (29%) had fast recovery from CS, defined as discharge alive from intensive care unit (ICU) within 3 days, questioning the necessity of any mechanical circulatory support (MCS).3 Given contrasting outcomes and the different patient populations of the two trials, we aimed to better characterize patients with intrinsic fast recovery from AMI-CS. This post hoc exploratory analysis of the ECLS-SHOCK trial which randomized AMI-CS patients to either early ECLS plus standard medical therapy or standard medical therapy alone; ECLS was started during index catheterization. Standard-care patients were escalated to MCS (other than ECLS) only according to strict predefined criteria.