National Use Patterns and Comparative Effectiveness of Extracorporeal Membrane Oxygenation in Myocardial Infarction–Related Cardiogenic Shock
6 affiliations
- 1Harvard Medical School
- 2Brigham and Women's Hospital
- 3Beth Israel Deaconess Medical Center
- 4Food and Drug Administration
- 5Tufts Medical Center
- 6Copenhagen University Hospital Rigshospitalet
Abstract
Background Extracorporeal membrane oxygenation (ECMO) provides bi‐ventricular support for patients with myocardial infarction–related cardiogenic shock (MI‐CS); comparative effectiveness data relative to other mechanical circulatory support remain limited. We characterize contemporary ECMO utilization for MI‐CS and compare short‐term mortality across ECMO and non‐ECMO treatment strategies. Methods We compared baseline characteristics and temporal trends in mechanical circulatory support utilization among Medicare beneficiaries hospitalized with MI‐CS from 2016 to 2023 and treated with ECMO, Impella, intra‐aortic balloon pump, or medical management alone. Patient outcomes for each group were evaluated using inverse probability of treatment weighting, G‐formula approach, and grace period analysis. The primary endpoint was 30‐day all‐cause mortality. Results The cohort included 102 718 patients: 1165 (1.1%) treated with ECMO, 10 064 (9.8%) Impella, 24 631 (24.0%) intra‐aortic balloon pump, and 66 858 (65.1%) medical management alone. From 2016 to 2023, ECMO use for MI‐CS increased from 0.8% to 1.8%. The percentage of hospitals using ECMO increased from 9.2% to 17.1%. Unadjusted 30‐day mortality was higher for ECMO (69%) compared with Impella (60%), intra‐aortic balloon pump (39%), and medical management (46%) (all P<0.0001). Adjusted inverse probability of treatment weighting and G‐formula analyses revealed a 30‐day mortality rate of 68%–70% for ECMO, which was higher than that for other therapies. The grace period analysis revealed similar mortality between patients treated with ECMO (54%) and Impella (54%). Conclusions ECMO use in a contemporary Medicare cohort of patients with MI‐CS was infrequent (1.1%) and associated with high 30‐day mortality. Despite use of complementary causal inference methods, we were unable to establish valid causal inferences on ECMO use and patient survival.
Related
- Utilization of Preventive Single-Inflow Cannula Left Atrial Veno-Arterial Extracorporeal Membrane Oxygenation in Cardiogenic Shock
- Single cell and bulk transcriptomics reveal metabolic reprogramming biomarker signatures during extracorporeal membrane oxygenation for cardiogenic shock
- Clinical outcomes of primary Impella 5.5 versus transition from extracorporeal membrane oxygenation in cardiogenic shock: A Spanish multicenter cohort.
- Myocardial injury patterns on cardiac magnetic resonance: diffuse myocardial damage with prominent septal involvement in adults with severe myocarditis requiring extracorporeal membrane oxygenation
- Effectiveness of prenatal predictors for congenital diaphragmatic hernia on survival to discharge and extracorporeal membrane oxygenation requirement: a retrospective cohort study.
BibTeX
@article{kochar2026national,
title = {{National Use Patterns and Comparative Effectiveness of Extracorporeal Membrane Oxygenation in Myocardial Infarction–Related Cardiogenic Shock}},
author = {Ajar Kochar and Christina Lalani and Yang Song and Zaid Almarzooq and Andrew Farb and Changfu Wu and Bram Zuckerman and Navin K. Kapur and Jacob E. Moller and Eric A. Secemsky and Arthur R. Garan and Robert W. Yeh},
journal = {Journal of the American Heart Association},
year = {2026},
month = oct,
doi = {10.1161/jaha.126.049443},
url = {https://www.ahajournals.org/doi/10.1161/JAHA.126.049443},
note = {CC BY},
}
RIS
TY - JOUR
TI - National Use Patterns and Comparative Effectiveness of Extracorporeal Membrane Oxygenation in Myocardial Infarction–Related Cardiogenic Shock
AU - Ajar Kochar
AU - Christina Lalani
AU - Yang Song
AU - Zaid Almarzooq
AU - Andrew Farb
AU - Changfu Wu
AU - Bram Zuckerman
AU - Navin K. Kapur
AU - Jacob E. Moller
AU - Eric A. Secemsky
AU - Arthur R. Garan
AU - Robert W. Yeh
PY - 2026
DA - 2026/10/30
JO - Journal of the American Heart Association
DO - 10.1161/jaha.126.049443
UR - https://www.ahajournals.org/doi/10.1161/JAHA.126.049443
AB - Background Extracorporeal membrane oxygenation (ECMO) provides bi‐ventricular support for patients with myocardial infarction–related cardiogenic shock (MI‐CS); comparative effectiveness data relative to other mechanical circulatory support remain limited. We characterize contemporary ECMO utilization for MI‐CS and compare short‐term mortality across ECMO and non‐ECMO treatment strategies. Methods We compared baseline characteristics and temporal trends in mechanical circulatory support utilization among Medicare beneficiaries hospitalized with MI‐CS from 2016 to 2023 and treated with ECMO, Impella, intra‐aortic balloon pump, or medical management alone. Patient outcomes for each group were evaluated using inverse probability of treatment weighting, G‐formula approach, and grace period analysis. The primary endpoint was 30‐day all‐cause mortality. Results The cohort included 102 718 patients: 1165 (1.1%) treated with ECMO, 10 064 (9.8%) Impella, 24 631 (24.0%) intra‐aortic balloon pump, and 66 858 (65.1%) medical management alone. From 2016 to 2023, ECMO use for MI‐CS increased from 0.8% to 1.8%. The percentage of hospitals using ECMO increased from 9.2% to 17.1%. Unadjusted 30‐day mortality was higher for ECMO (69%) compared with Impella (60%), intra‐aortic balloon pump (39%), and medical management (46%) (all P<0.0001). Adjusted inverse probability of treatment weighting and G‐formula analyses revealed a 30‐day mortality rate of 68%–70% for ECMO, which was higher than that for other therapies. The grace period analysis revealed similar mortality between patients treated with ECMO (54%) and Impella (54%). Conclusions ECMO use in a contemporary Medicare cohort of patients with MI‐CS was infrequent (1.1%) and associated with high 30‐day mortality. Despite use of complementary causal inference methods, we were unable to establish valid causal inferences on ECMO use and patient survival.
SN - 2047-9980
ER -