Application of VA-ECMO in high-risk percutaneous coronary interventions under different clinical conditions

doi:10.3969/j.issn.1674-8115.2026.01.015

Abstract

Abstract:

Although coronary artery bypass grafting (CABG) remains the preferred treatment for most patients with complex coronary artery lesions, percutaneous coronary intervention (PCI) supported by mechanical circulatory support (MCS) may be a non-inferior or even superior alternative in specific cases, particularly in critically ill patients with hemodynamic instability. Recent real-world evidence has led to a downgrade in guideline recommendations for the intra-aortic balloon pump (IABP), which has been the most commonly used circulatory assist device in clinical practice. Due to limited availability, the Impella device has not yet been widely adopted in China. In contrast, veno-arterial extracorporeal membrane oxygenation (VA-ECMO), owing to its comprehensive and robust cardiopulmonary replacement capabilities, has seen an increase in utilization across China in recent years. This article reviews current evidence on the application of VA-ECMO in high-risk PCI (HR-PCI) under various clinical conditions, aiming to provide valuable references for clinical practice.

Key words: veno-arterial extracorporeal membrane oxygenation (VA-ECMO), percutaneous coronary intervention (PCI), extracorporeal cardiopulmonary resuscitation (ECPR), cardiogenic shock (CS)

CLC Number:

R541.4

Deng Yuying, Huang Xiuxian, Wang Sheng. Application of VA-ECMO in high-risk percutaneous coronary interventions under different clinical conditions[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2026, 46(1): 123-131.

Figures/Tables 3

TrendMD

References 51

[1]	Rihal C S, Naidu S S, Givertz M M, et al. 2015 SCAI/ACC/HFSA/STS clinical expert consensus statement on the use of percutaneous mechanical circulatory support devices in cardiovascular care (endorsed by the American heart association, the cardiological society of India, and sociedad Latino Americana de cardiologia intervencion; affirmation of value by the Canadian association of interventional cardiology-association canadienne de cardiologie d'intervention)[J]. J Card Fail, 2015, 21(6): 499-518.
[2]	Chieffo A, Dudek D, Hassager C, et al. Joint EAPCI/ACVC expert consensus document on percutaneous ventricular assist devices[J]. Eur Heart J Acute Cardiovasc Care, 2021, 10(5): 570-583.
[3]	Nishimura T, Hirata Y, Ise T, et al. JCS/JSCVS/JCC/CVIT 2023 guideline focused update on indication and operation of PCPS/ECMO/IMPELLA[J]. Circ J, 2024, 88(6): 1010-1046.
[4]	Van Den Buijs D M F, Wilgenhof A, Knaapen P, et al. Prophylactic impella CP versus VA-ECMO in patients undergoing complex high-risk indicated PCI[J]. J Interv Cardiol, 2022, 2022: 8167011.
[5]	Wampler D A, Collett L, Manifold C A, et al. Cardiac arrest survival is rare without prehospital return of spontaneous circulation[J]. Prehospital Emerg Care, 2012, 16(4): 451-455.
[6]	Drennan I R, Lin S, Sidalak D E, et al. Survival rates in out-of-hospital cardiac arrest patients transported without prehospital return of spontaneous circulation: an observational cohort study[J]. Resuscitation, 2014, 85(11): 1488-1493.
[7]	Grunau B, Kime N, Leroux B, et al. Association of intra-arrest transport vs continued on-scene resuscitation with survival to hospital discharge among patients with out-of-hospital cardiac arrest[J]. JAMA, 2020, 324(11): 1058-1067.
[8]	Panchal A R, Bartos J A, Cabanas J G, et al. Part 3: Adult basic and advanced life support: 2020 American heart association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care[J]. Circulation, 2020, 142(16_suppl_2): S366-S468.
[9]	Lott C, Truhlář A, Alfonzo A, et al. European Resuscitation Council Guidelines 2021: cardiac arrest in special circumstances[J]. Resuscitation, 2021, 161: 152-219.
[10]	Haneya A, Philipp A, Diez C, et al. A 5-year experience with cardiopulmonary resuscitation using extracorporeal life support in non-postcardiotomy patients with cardiac arrest[J]. Resuscitation, 2012, 83(11): 1331-1337.
[11]	Chung S Y, Sheu J J, Lin Y J, et al. Outcome of patients with profound cardiogenic shock after cardiopulmonary resuscitation and prompt extracorporeal membrane oxygenation support: a single-center observational study [J]. Circ J, 2012, 76(6): 1385-1392.
[12]	Bougouin W, Dumas F, Lamhaut L, et al. Extracorporeal cardiopulmonary resuscitation in out-of-hospital cardiac arrest: a registry study[J]. Eur Heart J, 2020, 41(21): 1961-1971.
[13]	Rob D, Smalcova J, Smid O, et al. Extracorporeal versus conventional cardiopulmonary resuscitation for refractory out-of-hospital cardiac arrest: a secondary analysis of the Prague OHCA trial[J]. Crit Care, 2022, 26(1): 330.
[14]	Chen Y S, Lin J W, Yu H Y, et al. Cardiopulmonary resuscitation with assisted extracorporeal life-support versus conventional cardiopulmonary resuscitation in adults with in-hospital cardiac arrest: an observational study and propensity analysis[J]. Lancet, 2008, 372(9638): 554-561.
[15]	Maekawa K, Tanno K, Hase M, et al. Extracorporeal cardiopulmonary resuscitation for patients with out-of-hospital cardiac arrest of cardiac origin: a propensity-matched study and predictor analysis[J]. Crit Care Med, 2013, 41(5): 1186-1196.
[16]	Sakamoto T, Morimura N, Nagao K, et al. Extracorporeal cardiopulmonary resuscitation versus conventional cardiopulmonary resuscitation in adults with out-of-hospital cardiac arrest: a prospective observational study[J]. Resuscitation, 2014, 85(6): 762-768.
[17]	Bartos J A, Grunau B, Carlson C, et al. Improved survival with extracorporeal cardiopulmonary resuscitation despite progressive metabolic derangement associated with prolonged resuscitation[J]. Circulation, 2020, 141(11): 877-886.
[18]	Yannopoulos D, Bartos J, Raveendran G, et al. Advanced reperfusion strategies for patients with out-of-hospital cardiac arrest and refractory ventricular fibrillation (ARREST): a phase 2, single centre, open-label, randomised controlled trial[J]. Lancet, 2020, 396(10265): 1807-1816.
[19]	Belohlavek J, Smalcova J, Rob D, et al. Effect of intra-arrest transport, extracorporeal cardiopulmonary resuscitation, and immediate invasive assessment and treatment on functional neurologic outcome in refractory out-of-hospital cardiac arrest: a randomized clinical trial[J]. JAMA, 2022, 327(8): 737-747.
[20]	Grunau B, Reynolds J, Scheuermeyer F, et al. Relationship between time-to-ROSC and survival in out-of-hospital cardiac arrest ECPR candidates: when is the best time to consider transport to hospital?[J]. Prehospital Emerg Care, 2016, 20(5): 615-622.
[21]	Jeger R V, Radovanovic D, Hunziker P R, et al. Ten-year trends in the incidence and treatment of cardiogenic shock[J]. Ann Intern Med, 2008, 149(9): 618-626.
[22]	Wayangankar S A, Bangalore S, Mccoy L A, et al. Temporal trends and outcomes of patients undergoing percutaneous coronary interventions for cardiogenic shock in the setting of acute myocardial infarction: a report from the CathPCI REGISTRY[J]. JACC Cardiovasc Interv, 2016, 9(4): 341-351.
[23]	Thiele H, Akin I, Sandri M, et al. PCI strategies in patients with acute myocardial infarction and cardiogenic shock[J]. N Engl J Med, 2017, 377(25): 2419-2432.
[24]	O′Gara P T, Kushner F G, Ascheim D D, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines[J]. Circulation, 2013, 127(4): e362-e425.
[25]	Neumann F J, Sousa-Uva M, Ahlsson A, et al. 2018 ESC/EACTS guidelines on myocardial revascularization[J]. EuroIntervention, 2019, 14(14): 1435-1534.
[26]	Thiele H, Zeymer U, Neumann F J, et al. Intra-aortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock (IABP-SHOCK Ⅱ): final 12 month results of a randomised, open-label trial[J]. Lancet, 2013, 382(9905): 1638-1645.
[27]	Thiele H, Zeymer U, Neumann F J, et al. Intraaortic balloon support for myocardial infarction with cardiogenic shock[J]. N Engl J Med, 2012, 367(14): 1287-1296.
[28]	Sheu J J, Tsai T H, Lee F Y, et al. Early extracorporeal membrane oxygenator-assisted primary percutaneous coronary intervention improved 30-day clinical outcomes in patients with ST-segment elevation myocardial infarction complicated with profound cardiogenic shock[J]. Crit Care Med, 2010, 38(9): 1810-1817.
[29]	Tsao N W, Shih C M, Yeh J S, et al. Extracorporeal membrane oxygenation-assisted primary percutaneous coronary intervention may improve survival of patients with acute myocardial infarction complicated by profound cardiogenic shock[J]. J Crit Care, 2012, 27(5): 530.e1-530.e11.
[30]	Chung E S, Lim C, Lee H Y, et al. Results of extracorporeal membrane oxygenation (ECMO) support before coronary reperfusion in cardiogenic shock with acute myocardial infarction[J]. Korean J Thorac Cardiovasc Surg, 2011, 44(4): 273-278.
[31]	Kim H, Lim S H, Hong J, et al. Efficacy of veno-arterial extracorporeal membrane oxygenation in acute myocardial infarction with cardiogenic shock[J]. Resuscitation, 2012, 83(8): 971-975.
[32]	Wu M-Y, Tseng Y H, Chang Y S, et al. Using extracorporeal membrane oxygenation to rescue acute myocardial infarction with cardiopulmonary collapse: the impact of early coronary revascularization[J]. Resuscitation, 2013, 84(7): 940-945.
[33]	Chung S Y, Tong M S, Sheu J J, et al. Short-term and long-term prognostic outcomes of patients with ST-segment elevation myocardial infarction complicated by profound cardiogenic shock undergoing early extracorporeal membrane oxygenator-assisted primary percutaneous coronary intervention[J]. Int J Cardiol, 2016, 223: 412-417.
[34]	Sakamoto S, Taniguchi N, Nakajima S, et al. Extracorporeal life support for cardiogenic shock or cardiac arrest due to acute coronary syndrome[J]. Ann Thorac Surg, 2012, 94(1): 1-7.
[35]	Lackermair K, Brunner S, Orban M, et al. Outcome of patients treated with extracorporeal life support in cardiogenic shock complicating acute myocardial infarction: 1-year result from the ECLS-Shock study[J]. Clin Res Cardiol, 2021, 110(9): 1412-1420.
[36]	Banning A S, Sabaté M, Orban M, et al. Venoarterial extracorporeal membrane oxygenation or standard care in patients with cardiogenic shock complicating acute myocardial infarction: the multicentre, randomised EURO SHOCK trial[J]. EuroIntervention, 2023, 19(6): 482-492.
[37]	Huang C C, Hsu J C, Wu Y W, et al. Implementation of extracorporeal membrane oxygenation before primary percutaneous coronary intervention may improve the survival of patients with ST-segment elevation myocardial infarction and refractory cardiogenic shock[J]. Int J Cardiol, 2018, 269: 45-50.
[38]	Choi K H, Yang J H, Hong D, et al. Optimal timing of venoarterial-extracorporeal membrane oxygenation in acute myocardial infarction patients suffering from refractory cardiogenic shock[J]. Circ J, 2020, 84(9): 1502-1510.
[39]	Kim M C, Ahn Y, Cho K H, et al. Benefit of extracorporeal membrane oxygenation before revascularization in patients with acute myocardial infarction complicated by profound cardiogenic shock after resuscitated cardiac arrest[J]. Korean Circ J, 2021, 51(6): 533-544.
[40]	Shaukat A, Hryniewicz-Czeneszew K, Sun B, et al. Outcomes of extracorporeal membrane oxygenation support for complex high-risk elective percutaneous coronary interventions: a single-center experience and review of the literature[J]. J Invasive Cardiol, 2018, 30(12): 456-460.
[41]	Tomasello S D, Boukhris M, Ganyukov V, et al. Outcome of extracorporeal membrane oxygenation support for complex high-risk elective percutaneous coronary interventions: a single-center experience[J]. Heart Lung, 2015, 44(4): 309-313.
[42]	Van Den Brink F S, Meijers T A, Hofma S H, et al. Prophylactic veno-arterial extracorporeal membrane oxygenation in patients undergoing high-risk percutaneous coronary intervention[J]. Neth Heart J, 2020, 28(3): 139-144.
[43]	Griffioen A M, Van Den Oord S C H, Van Wely M H, et al. Short-term outcomes of elective high-risk PCI with extracorporeal membrane oxygenation support: a single-centre registry[J]. J Interv Cardiol, 2022, 2022: 7245384.
[44]	Perera D, Stables R, Clayton T, et al. Long-term mortality data from the balloon pump-assisted coronary intervention study (BCIS-1): a randomized, controlled trial of elective balloon counterpulsation during high-risk percutaneous coronary intervention[J]. Circulation, 2013, 127(2): 207-212.
[45]	Patel M R, Smalling R W, Thiele H, et al. Intra-aortic balloon counterpulsation and infarct size in patients with acute anterior myocardial infarction without shock: the CRISP AMI randomized trial[J]. JAMA, 2011, 306(12): 1329-1337.
[46]	Stone G W, Marsalese D, Brodie B R, et al. A prospective, randomized evaluation of prophylactic intraaortic balloon counterpulsation in high risk patients with acute myocardial infarction treated with primary angioplasty[J]. J Am Coll Cardiol, 1997, 29(7): 1459-1467.
[47]	Schweitzer J, Horn P, Voss F, et al. Incidence of acute kidney injury is lower in high-risk patients undergoing percutaneous coronary intervention supported with impella compared to ECMO[J]. J Cardiovasc Transl Res, 2022, 15(2): 239-248.
[48]	O′Neill B P, Grines C, Moses J W, et al. Outcomes of bailout percutaneous ventricular assist device versus prophylactic strategy in patients undergoing nonemergent percutaneous coronary intervention[J]. Catheter Cardiovasc Interv, 2021, 98(4): E501-E512.
[49]	Tarantini G, Masiero G, Burzotta F, et al. Timing of Impella implantation and outcomes in cardiogenic shock or high-risk percutaneous coronary revascularization[J]. Catheter Cardiovasc Interv, 2021, 98(2): E222-E234.
[50]	Briguori C, Sarais C, Pagnotta P, et al. Elective versus provisional intra-aortic balloon pumping in high-risk percutaneous transluminal coronary angioplasty[J]. Am Heart J, 2003, 145(4): 700-707.
[51]	Danek B A, Basir M B, O'Neill W W, et al. Mechanical circulatory support in chronic total occlusion percutaneous coronary intervention: insights from a multicenter U.S. registry[J]. J Invasive Cardiol, 2018, 30(3): 81-87.

Author	Type of study	Patient	Group	Endpoint	Result
Haneya A et al^[10]	5-year retrospective study	Adult patients treated with ECLS between January 2007 and January 2012 (n=85)	—	—	Mean ECLS support duration was 49 h (12‒92 h). 28 patients (33%) had ECLS-related complications. 40 patients (47%) were successfully weaned and 29 patients (34%) survived to hospital discharge. Among survivors, 93% had no severe neurologic deficit
Chung S Y et al^[11]	Single-center prospective observational study	Patients with profound CS undergoing (10‒15) min of cardiopulmonary cerebral resuscitation (CPCR) and VA-ECMO (n=134)	—	—	Duration of VA-ECMO implantation was 5.1±5.7 days. In-hospital mortality was 57.5%. 68 patients (50.7%) were successfully weaned from VA-ECMO and 57 (42.5%) were discharged alive
Bougouin W et al^[12]	Prospective registry study	Patients with OHCA in the Paris region from May 2011 to January 2018	Conventional CPR (n=12 666) vs ECPR (n=525)	Survival at hospital discharge	ECPR was not associated with increased hospital survival. Early VA-ECMO implantation may improve outcomes
Chen Y S et al^[14]	3-year prospective observational study	Patients aged (18‒75) years with witnessed in-hospital cardiac arrest of cardiac origin undergoing CPR of more than 10 min	Conventional CPR group (n=113) vs ECPR group (n=59)	Survival to hospital discharge	Survival to hospital discharge (P<0.000 1), 30-day survival (P=0.003), and 1-year survival (P=0.006) were significantly higher in the ECPR group than in the conventional CPR group
Maekawa K et al^[15]	Post hoc analysis of data from a prospective observational cohort	Patients with witnessed cardiac arrest of cardiac origin who had undergone CPR for longer than 20 min	Conventional CPR group (n=109) vs ECPR group (n=53)	Neurologically intact survival at 3 months after cardiac arrest	Intact survival rate was higher in the matched ECPR group than in the matched conventional CPR group [29.2% (7/24) vs. 8.3% (2/24), log-rank P=0.018]
Sakamoto T et al^[16]	Prospective observational study	OHCA patients	Non-ECPR group (n=20) vs ECPR group(n=26)	Rate of favorable outcomes defined by the Glasgow-Pittsburgh Cerebral Performance Category (CPC) 1 or 2 at 1 and 6 months after OHCA	CPC 1 or 2 rates were 12.3% (32/260) in the ECPR group and 1.5% (3/194) in the non-ECPR group at 1 month (P<0.000 1), and 11.2% (29/260) and 2.6% (5/194) at 6 months (P=0.001), respectively. By per-protocol analysis, CPC 1 or 2 were 13.7% (32/234) in the ECPR group and 1.9% (3/159) in the non-ECPR group at 1 month (P<0.000 1), and 12.4% (29/234) and 3.1% (5/159) at 6 months (P=0.002), respectively
Bartos J A et al^[17]	Retrospective analysis	Adults with refractory ventricular fibrillation/ventricular tachycardia and OHCA	ECPR patients (n=160) vs standard CPR patients (n=654)	Neurologically favorable survival	Neurologically favorable survival was significantly higher in ECPR patients than in standard CPR patients (33% versus 23%;P=0.01) overall

Author	Type of study	Patient	Group	Endpoint	Result
Haneya A et al^[10]	5-year retrospective study	Adult patients treated with ECLS between January 2007 and January 2012 (n=85)	—	—	Mean ECLS support duration was 49 h (12‒92 h). 28 patients (33%) had ECLS-related complications. 40 patients (47%) were successfully weaned and 29 patients (34%) survived to hospital discharge. Among survivors, 93% had no severe neurologic deficit
Chung S Y et al^[11]	Single-center prospective observational study	Patients with profound CS undergoing (10‒15) min of cardiopulmonary cerebral resuscitation (CPCR) and VA-ECMO (n=134)	—	—	Duration of VA-ECMO implantation was 5.1±5.7 days. In-hospital mortality was 57.5%. 68 patients (50.7%) were successfully weaned from VA-ECMO and 57 (42.5%) were discharged alive
Bougouin W et al^[12]	Prospective registry study	Patients with OHCA in the Paris region from May 2011 to January 2018	Conventional CPR (n=12 666) vs ECPR (n=525)	Survival at hospital discharge	ECPR was not associated with increased hospital survival. Early VA-ECMO implantation may improve outcomes
Chen Y S et al^[14]	3-year prospective observational study	Patients aged (18‒75) years with witnessed in-hospital cardiac arrest of cardiac origin undergoing CPR of more than 10 min	Conventional CPR group (n=113) vs ECPR group (n=59)	Survival to hospital discharge	Survival to hospital discharge (P<0.000 1), 30-day survival (P=0.003), and 1-year survival (P=0.006) were significantly higher in the ECPR group than in the conventional CPR group
Maekawa K et al^[15]	Post hoc analysis of data from a prospective observational cohort	Patients with witnessed cardiac arrest of cardiac origin who had undergone CPR for longer than 20 min	Conventional CPR group (n=109) vs ECPR group (n=53)	Neurologically intact survival at 3 months after cardiac arrest	Intact survival rate was higher in the matched ECPR group than in the matched conventional CPR group [29.2% (7/24) vs. 8.3% (2/24), log-rank P=0.018]
Sakamoto T et al^[16]	Prospective observational study	OHCA patients	Non-ECPR group (n=20) vs ECPR group(n=26)	Rate of favorable outcomes defined by the Glasgow-Pittsburgh Cerebral Performance Category (CPC) 1 or 2 at 1 and 6 months after OHCA	CPC 1 or 2 rates were 12.3% (32/260) in the ECPR group and 1.5% (3/194) in the non-ECPR group at 1 month (P<0.000 1), and 11.2% (29/260) and 2.6% (5/194) at 6 months (P=0.001), respectively. By per-protocol analysis, CPC 1 or 2 were 13.7% (32/234) in the ECPR group and 1.9% (3/159) in the non-ECPR group at 1 month (P<0.000 1), and 12.4% (29/234) and 3.1% (5/159) at 6 months (P=0.002), respectively
Bartos J A et al^[17]	Retrospective analysis	Adults with refractory ventricular fibrillation/ventricular tachycardia and OHCA	ECPR patients (n=160) vs standard CPR patients (n=654)	Neurologically favorable survival	Neurologically favorable survival was significantly higher in ECPR patients than in standard CPR patients (33% versus 23%;P=0.01) overall

Author	Patient	Mean support time	Successfully weaned	Survival	Risk of non-weaning VA-ECMO	Risk of mortality
Chung E S et al^[30]	Patients with CS due to AMI between May 2006 and November 2009 (n=20)	(3.8±4.0) days	14 (70%)	10 patients survived to hospital discharge. Survivors had a mean follow-up duration of (476.6±374.6) days	—	Longer CPR duration and ECMO support time, elevated cardiac enzyme levels, lower ejection fraction, lower serum albumin levels, and major complications (P<0.05)
Kim H et al^[31]	Patients requiring VA-ECMO for AMI complicated with CS between April 2006 and July 2010 (n=27)	(30.2±30.1) hours	22 (81.5%)	16 patients (59.3%) survived to hospital discharge. The 30-day survival was 63.0% (17/27)	The interval between CPR initiation and VA-ECMO commencement	High pre-ECMO serum lactate level
Wu M Y et al^[32]	Patients rescued by VA-ECMO for AMI-induced cardiopulmonary collapse between June 2003 and December 2011 (n=35)	[66 (2‒259)] hours for PCI and [100 (43‒504)] hours for CABG	22 (63%)	The hospital discharge rate was 40%. Major adverse cardiovascular event (MACE)-free survival was 77% in the first year after discharge	Dialysis-dependent acute renal failure (OR=5.4, 95% CI: 1.1‒27.5) and profound anoxic encephalopathy (OR=5.3, 95% CI: 1.2‒27.3)	Age>60 years (OR=7.3, 95% CI: 1.1‒51.0) and profound anoxic encephalopathy (OR=24.6, 95% CI: 2.3‒263.0)
Chung S Y et al^[33]	STEMI patients with profound CS who underwent routine ECMO-supported primary PCI between December 2005 and December 2014 (n=65)	(6.8±7.5) days for 30-day survivors and (4.9±4.0) days for 30-day non-survivors	45 (69.2%)	The long-term cumulative survival rate was 32.3% (21/65) with a mean follow-up of (734±987) days	—	Unsuccessful reperfusion, failed VA-ECMO weaning, and peak creatinine level (all P<0.01)
Sakamoto S et al^[34]	ACS patients who received ECLS to reverse hemodynamic collapse refractory to conventional treatment (n=98)	(68.9±62.7) hours	54 (55.1%)	The survival rate to hospital discharge was 32.7%	—	Unsuccessful angioplasty, asystole or pulseless electrical activity before ECLS initiation, and ECLS-related complications

Author	Patient	Mean support time	Successfully weaned	Survival	Risk of non-weaning VA-ECMO	Risk of mortality
Chung E S et al^[30]	Patients with CS due to AMI between May 2006 and November 2009 (n=20)	(3.8±4.0) days	14 (70%)	10 patients survived to hospital discharge. Survivors had a mean follow-up duration of (476.6±374.6) days	—	Longer CPR duration and ECMO support time, elevated cardiac enzyme levels, lower ejection fraction, lower serum albumin levels, and major complications (P<0.05)
Kim H et al^[31]	Patients requiring VA-ECMO for AMI complicated with CS between April 2006 and July 2010 (n=27)	(30.2±30.1) hours	22 (81.5%)	16 patients (59.3%) survived to hospital discharge. The 30-day survival was 63.0% (17/27)	The interval between CPR initiation and VA-ECMO commencement	High pre-ECMO serum lactate level
Wu M Y et al^[32]	Patients rescued by VA-ECMO for AMI-induced cardiopulmonary collapse between June 2003 and December 2011 (n=35)	[66 (2‒259)] hours for PCI and [100 (43‒504)] hours for CABG	22 (63%)	The hospital discharge rate was 40%. Major adverse cardiovascular event (MACE)-free survival was 77% in the first year after discharge	Dialysis-dependent acute renal failure (OR=5.4, 95% CI: 1.1‒27.5) and profound anoxic encephalopathy (OR=5.3, 95% CI: 1.2‒27.3)	Age>60 years (OR=7.3, 95% CI: 1.1‒51.0) and profound anoxic encephalopathy (OR=24.6, 95% CI: 2.3‒263.0)
Chung S Y et al^[33]	STEMI patients with profound CS who underwent routine ECMO-supported primary PCI between December 2005 and December 2014 (n=65)	(6.8±7.5) days for 30-day survivors and (4.9±4.0) days for 30-day non-survivors	45 (69.2%)	The long-term cumulative survival rate was 32.3% (21/65) with a mean follow-up of (734±987) days	—	Unsuccessful reperfusion, failed VA-ECMO weaning, and peak creatinine level (all P<0.01)
Sakamoto S et al^[34]	ACS patients who received ECLS to reverse hemodynamic collapse refractory to conventional treatment (n=98)	(68.9±62.7) hours	54 (55.1%)	The survival rate to hospital discharge was 32.7%	—	Unsuccessful angioplasty, asystole or pulseless electrical activity before ECLS initiation, and ECLS-related complications

Author	Type of study	Patient	Mean age	Male	Duration of VA-ECMO	ECMO-related complication	Mortality of MACCE/MACE
Shaukat A et al^[40]	Single-center experience	n=5	(66.8±8.6) years	5 (100%)	<24 hours in 4 cases	1 patient required femoral artery surgical repair	There was no occurrence of in-hospital and 1-year MACCE
Tomasello S D et al^[41]	Single-center experience	n=12	(63.5±8.7) years	8 (66.7%)	(95.4±25.2) min	A groin hematoma at the arterial cannulation site (BARC type 2) occurred in 1 patient (8.3%). Worsening renal function occurred in 4 patients (33.3%)	No in-hospital MACCE was observed. At 6 months, neither death nor MI was reported
Van Den Brink F S et al^[42]	Two-center retrospective study	n=14	[69 (53‒83)] years	13 (92%)	[2.57 (1‒4)] hours	1 patient developed a transient ischemic attack after the procedure and 1 patient developed a thrombus in the femoral vein used for cannulation several days after decannulation	Survival was 93% (13/14). One patient died during hospitalization due to refractory cardiac failure
Griffioen A M et al^[43]	Single-centre registry	n=14	(66.5±2.5) years	10 (71.4%)	(151±32) min	A minor vascular complication at the vascular access site occurred in 1 patient (7.1%)	MACE during hospital stay occurred in 4 patients (28.6%) and within 60 days after discharge in 2 patients (16.7%)