ECMO use in Takotsubo cardiomyopathy with cardiogenic shock did not significantly reduce in-hospital mortality (32.5% vs. 26.7%; P=0.49) but increased hospital costs.
Does extracorporeal membrane oxygenation reduce in-hospital mortality in adult patients hospitalized with Takotsubo cardiomyopathy and cardiogenic shock?
In patients with Takotsubo cardiomyopathy complicated by cardiogenic shock, the use of ECMO was not associated with a significant reduction in in-hospital mortality.
Background Takotsubo cardiomyopathy (TCM) is an acute form of left-ventricular systolic dysfunction triggered by emotional or physical stress, which can lead to refractory cardiogenic shock. In such cases, mechanical cardiovascular support, such as extracorporeal membrane oxygenation (ECMO), may be beneficial. However, the outcomes of ECMO in this population remain unclear. Objective To evaluate the association between ECMO and in-hospital outcomes in patients hospitalized with TCM and cardiogenic shock. Methods We conducted a retrospective cohort study using the National Inpatient Sample from 2016 to 2022 to evaluate outcomes in adult patients hospitalized with TCM and cardiogenic shock. ECMO use was identified using ICD-10 procedure codes. The primary outcome was in-hospital mortality. Secondary outcomes included hospital length of stay (LOS), total hospital charges (THCs), acute kidney injury, and bleeding complications. Propensity score matching with double adjustment using survey-weighted logistic and linear regression was used to adjust for confounders. Results A total of 20 350 weighted hospitalizations were included, with 300 patients (1. 5%) receiving ECMO. In the unadjusted analysis, ECMO was associated with higher in-hospital mortality (35. 0 vs. 27. 7%), longer LOS (19. 4 vs. 12. 1 days), and higher THCs (761 206 vs. 254 690). After matching, 270 patients were identified in each group. ECMO was still associated with higher THCs (630 317 vs. 372 195). In-hospital mortality remained higher in the ECMO group (32. 5% vs. 26. 7%), although not statistically significantly (P = 0. 49). Conclusion Among patients with TCM complicated by cardiogenic shock, ECMO was not associated with a significant reduction in mortality. Further studies are warranted to improve patient risk stratification and clarify the clinical value of ECMO in this population.
Puchongmart et al. (2026) studied this question. ECMO use in Takotsubo cardiomyopathy with cardiogenic shock did not significantly reduce in-hospital mortality (32.5% vs. 26.7%; P=0.49) but increased hospital costs.