The use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) for temporary mechanical circulatory support in various clinical scenarios has been increasing consistently, despite the lack of sufficient evidence regarding its benefit and safety from adequately powered randomized controlled trials. Although the ARREST trial (Advanced Reperfusion Strategies for Patients with Out-of-Hospital Cardiac Arrest and Refractory Ventricular Fibrillation) and a secondary analysis of the PRAGUE OHCA trial (Prague Out-of-Hospital Cardiac Arrest) provided some evidence in favor of VA-ECMO in the setting of out-of-hospital cardiac arrest, the INCEPTION trial (Early Initiation of Extracorporeal Life Support in Refractory Out-of-Hospital Cardiac Arrest) has not found a relevant improvement of short-term mortality with extracorporeal cardiopulmonary resuscitation. In addition, the results of the recently published ECLS-SHOCK trial (Extracorporeal Life Support in Cardiogenic Shock) and ECMO-CS trial (Extracorporeal Membrane Oxygenation in the Therapy of Cardiogenic Shock) discourage the routine use of VA-ECMO in patients with infarct-related cardiogenic shock. Ongoing clinical trials (ANCHOR [Assessment of ECMO in Acute Myocardial Infarction Cardiogenic Shock, NCT04184635], REVERSE [Impella CP With VA ECMO for Cardiogenic Shock, NCT03431467], UNLOAD ECMO [Left Ventricular Unloading to Improve Outcome in Cardiogenic Shock Patients on VA-ECMO, NCT05577195], PIONEER [Hemodynamic Support With ECMO and IABP in Elective Complex High-risk PCI, NCT04045873]) may clarify the usefulness of VA-ECMO in specific patient subpopulations and the efficacy of combined mechanical circulatory support strategies. Pending further data to refine patient selection and management recommendations for VA-ECMO, it remains uncertain whether the present usage of this device improves outcomes.

中文翻译：

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仔细研究静脉动脉体外膜氧合的作用：临床实践是否超过了证据？

尽管缺乏足够的证据证明其益处和安全性，但在各种临床情况下使用静脉动脉体外膜肺氧合（VA-ECMO）作为临时机械循环支持的情况一直在不断增加。尽管 ARREST 试验（院外心脏骤停和难治性心室颤动患者的高级再灌注策略）和布拉格 OHCA 试验（布拉格院外心脏骤停）的二次分析提供了一些支持 VA 的证据，但ECMO 在院外心脏骤停的情况下，INCEPTION 试验（难治性院外心脏骤停中早期启动体外生命支持）尚未发现体外心肺复苏对短期死亡率的相关改善。此外，最近发表的 ECLS-SHOCK 试验（心源性休克的体外生命支持）和 ECMO-CS 试验（心源性休克的体外膜氧合）的结果阻碍了梗塞患者常规使用 VA-ECMO。相关的心源性休克。正在进行的临床试验（ANCHOR [ECMO 在急性心肌梗死心源性休克中的评估，NCT04184635]，REVERSE [Impella CP 使用 VA ECMO 治疗心源性休克，NCT03431467]，UNLOAD ECMO [左心室减负荷以改善使用 VA-ECMO 的心源性休克患者的预后，NCT05577195]，PIONEER [选择性复杂高危 PCI 中 ECMO 和 IABP 的血流动力学支持，NCT04045873]）可能会阐明 VA-ECMO 在特定患者亚群中的有用性以及联合机械循环支持策略的功效。在等待进一步的数据来完善 VA-ECMO 的患者选择和管理建议之前，目前尚不确定该设备的使用是否会改善结果。