Impact of Extracorporeal Membrane Oxygenation (ECMO) in Patients with Refractory Cardiogenic Shock: Analysis of Mortality and Hemodynamic Recovery - A Systematic Review
Bibliographic record
Abstract
Introduction: Extracorporeal membrane oxygenation (ECMO) is an advanced life support for critically ill patients with refractory cardiogenic shock. However, evidence on its impact on mortality, hemodynamic recovery, and complications remains heterogeneous. This review aims to systematically evaluate ECMO’s impact on mortality and hemodynamic recovery in adult patients with refractory cardiogenic shock, addressing gaps and variations in existing literature.Material and Methods: This systematic review followed PRISMA guidelines. Databases searched were PubMed, Cochrane Library, and Google Scholar. Two reviewers independently selected studies, extracted data, and assessed quality using the Newcastle–Ottawa Scale. Findings were synthesized narratively due to study heterogeneity.Results: Mortality rates ranged widely from 33 to 75%, reflecting differences in patient populations and timing of ECMO initiation. Early ECMO initiation within less than one hour of shock onset was associated with a 47 percent reduction in mortality risk. In-hospital mortality was approximately 40%, increasing to nearly 60% at one-year follow-up. Success rates for weaning patients off ECMO varied between 53% and 88%. Hemodynamic improvements following ECMO support included increased blood pressure, improved left ventricular ejection fraction, and decreased serum lactate levels. Complications were frequent and diverse, predominantly bleeding, stroke, renal failure, and limb ischemia. Bleeding complications are strongly correlated with mortality.Conclusions: ECMO provides crucial circulatory support in refractory cardiogenic shock, improving hemodynamic parameters but with persistently high mortality and complication rates. Early initiation and careful patient selection are vital for optimizing outcomes, underscoring the need for multidisciplinary management and further high-quality prospective studies.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.030 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.009 | 0.010 |
| Bibliometrics | 0.009 | 0.009 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".