Extracorporeal life support during cardiac arrest and cardiogenic shock—how good is the evidence really?

For emergency physicians and cardiologists, patients with refractory cardiac arrest or cardiogenic shock complicating myocardial infarction are children of sorrow: mortality is extremely high, and not much improvement can be reported for the last decades. At least the beneficial effect of early revascularization was clarified by the SHOCKTrial (1), with an estimated risk reduction (30-days/ 1-year-mortality) amounting to about 18% [relative risk (RR) 0.82 (95% CI 0.69–0.97)] by primary percutaneous intervention/primary coronary artery bypass grafting (2). Nevertheless mortality still remains high.