A large international study suggests that a simple four-point care bundle, applied within 24 hours of initiating veno-arterial extracorporeal membrane oxygenation (VA-ECMO), could significantly improve survival in adults with cardiogenic shock. 

Published in the eClinicalMedicine journal, the study has data collected from 7,950 patients across 577 centers in the Extracorporeal Life Support Organization (ELSO) registry. The study found that patients meeting all bundle criteria had a 55.9% survival rate to hospital discharge, compared with 39.4% among those who did not. This indicated a 16.5% increase. After adjusting for illness severity, the bundle remained strongly associated with survival (adjusted OR 1.85, 95% CI 1.68–2.04).

The bundle consisted of four early targets: maintaining mean arterial pressure above 65 mmHg, limiting PaCO₂ reduction to less than 50%, keeping peak inspiratory pressure under 30 mmHg, and balancing arterial oxygen levels between 60 and 150 mmHg.
Patients achieving the bundle not only lived longer but also experienced fewer complications. The risk of ischemic stroke dropped from 5.5% to 3.7%, brain death from 1.7% to 0.9%, and major bleeding from 19.9% to 15.6%. Cardiovascular complications also fell from 24.4% to 21.4%.

However, despite all the benefits, only 34.7% of patients met all four targets, highlighting gaps in early ECMO management. Notably, the institutional practice or inadequate monitoring might hinder the adoption of the ECMO bundle.