Cardiac index, SvO2 or pCO2 gap may determine benefit from ECMO in cardiogenic shock: post-hoc analysis of the multicenter, randomized ECMO-CS trial

Ostadal, P; Vondrakova, D; Rokyta, R; Karasek, J; Kruger, A; Janotka, M; Naar, J; Smalcova, J; Hubatova, M; Hromadka, M; Volovar, S; Seyfrydova, M; Linhart, A; Belohlavek, J

doi:10.1186/s13054-025-05513-5

Hemodynamics, fluids & transfusion

Cardiac index, SvO2 or pCO2 gap may determine benefit from extracorporeal membrane oxygenation (ECMO) in cardiogenic shock: post-hoc analysis of the multicenter, randomized ECMO-CS trial

Crit CarePublished 14 Jul 2025Secondary analysis of the ECMO-CS randomised trial

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Authors' conclusion

Measurement of cardiac index, pCO2 gap and SvO2 could improve the management of cardiogenic shock.

Study context

Population: Patients with cardiogenic shock in subgroups with low cardiac index, low SvO2 or high pCO2 gaprandomised in ECMO-CS
Participants: 117 patients

Comparison: Immediate ECMO vs early conservative strategy
Primary endpoint: All-cause mortality
Follow-up: 1 year

Methodological detailspost-hoc subgroup analysis, multicentre, Retrospectively registered

Post-hoc subgroup analysis
Multicentre
Retrospectively registered

Primary result

As reported in the abstract

1-year all-cause mortality by subgroup

Immediate ECMO vs Early conservativeHazard ratio (95% CI)P value

Cardiac index < 2.2 L/min/m² (data for 58); NNT 3.6

0.48(0.23–0.99)

P = 0.049

pCO2 gap > 0.8 kPa (data for 54); NNT 3.5

0.43(0.20–0.91)

P = 0.028

SvO2 < 60% (data for 95); NNT 2.8

0.34(0.17–0.67)

P = 0.002

Secondary outcomes

Outcome	← Lower risk with immediate ECMO ←→ Higher risk with immediate ECMO →	HR (95% CI)	P value
Composite of all-cause death or hemodynamic worsening requiring ECMO, by subgroupImmediate ECMO vs Early conservative · cardiac index < 2.2 L/min/m²	0.10.31310	0.30 (0.15–0.65)	P = 0.003
Composite of all-cause death or hemodynamic worsening requiring ECMO, by subgroupImmediate ECMO vs Early conservative · pCO2 gap > 0.8 kPa	0.10.31310	0.29 (0.13–0.62)	P = 0.001
Composite of all-cause death or hemodynamic worsening requiring ECMO, by subgroupImmediate ECMO vs Early conservative · SvO2 < 60%	0.10.31310	0.28 (0.14–0.57)	P < 0.001
	0.10.31310Hazard ratio (log scale)

Original publication

Cardiac index, SvO2 or pCO2 gap may determine benefit from ECMO in cardiogenic shock: post-hoc analysis of the multicenter, randomized ECMO-CS trial. Crit Care. Published 14 July 2025. doi:10.1186/s13054-025-05513-5

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