In this episode, recorded live at the Critical Care Canada Forum in Toronto, we dive into extracorporeal life support (ECLS) in cardiogenic shock, with Dr Sean van Diepen.
He is an Associate Professor at the University of Alberta, Co-Director of the CCU at the Mazankowski Alberta Heart Institute, and a leading voice in cardiac critical care.
Join us as we explore the evolving landscape of mechanical circulatory support, the latest evidence from the DANGER and ECLS-SHOCK trials, and the complexities of patient selection.
Key Topics Covered:
1. The Evolution of ECLS in Cardiogenic Shock
• The 25-year gap since the last positive cardiogenic shock trial.
• How mechanical circulatory support expanded despite limited evidence.
2. The DANGER Trial – Impella in AMI-Associated Cardiogenic Shock
• Mechanism and function of the Impella device.
• Trial results: 20% mortality reduction at 180 days.
• Complications: Limb ischemia, hemolysis, and high costs.
• Real-world application: Who actually qualifies?
3. ECLS-SHOCK Trial – ECMO for Cardiogenic Shock
• A "negative" trial, but a crucial wake-up call.
• No mortality benefit but significantly higher complication rates.
• Controversies: Inclusion of cardiac arrest patients and transition to destination therapy.
• Future directions: Can patient selection improve outcomes?
4. ECPR – Extracorporeal Support in Refractory Cardiac Arrest
• Review of the ARREST, PRAGUE, and INCEPTION trials.
• Why the evidence remains unclear and institution-dependent.
• The role of high-volume ECMO centers and standardized pathways.
5. The Future of ECLS – Cost, Ethics, and Decision-Making
• How should institutions decide who gets ECMO?
• The role of cardiogenic shock teams.
• Could AI play a role in decision-making?
• The challenge of resource allocation in a single-payer system.
Key Takeaways:
✅ Impella shows promise in carefully selected AMI shock patients but is costly and high-risk.
✅ ECMO for cardiogenic shock remains controversial—patient selection is key.
✅ ECPR is promising but needs further trials and structured implementation.
✅ Cardiogenic shock management should be a team decision, not an individual one.
🔊 Listen now and join the conversation on the future of cardiac critical care!
The Critical Care Commute Podcast