Temporal Trends in VA-ECMO and Concurrent Mechanical Circulatory Support for Cardiogenic Shock

In this analysis of the Cardiogenic Shock Working Group registry, 1,502 of 11,386 patients with cardiogenic shock received venoarterial extracorporeal membrane oxygenation (VA-ECMO), more than half with concurrent temporary mechanical circulatory support. Concurrent Impella 5.5, but not Impella CP or intra-aortic balloon pump (IABP), was associated with lower in-hospital mortality than VA-ECMO alone (adjusted odds ratio [aOR] 0.62). Overall mortality was 48.4 percent, higher among patients with acute myocardial infarction (AMI) than those with heart failure shock. Device trends from 2021 to 2025 showed rising use of microaxial flow pump alongside declining IABP use, with anoxic brain injury the strongest predictor of death.