Left ventricular unloading in patients on venoarterial extracorporeal membrane oxygenation therapy in cardiogenic shock
- Background: The benefit of prophylactic left ventricular (LV) unloading during venoarterial extracorporeal membrane oxygenation (VA-ECMO) in selected patients at risk of developing LV distension remains unclear. Methods: We enrolled 136 patients treated with Impella pump decompression during VA-ECMO therapy for refractory cardiogenic shock. Patients were stratified by specific indication for LV unloading in the prophylactic vs. bail-out group. The bail-out unloading strategy was utilized to treat LV distension in VA-ECMO afterload-associated complications. The primary endpoint was all-cause 30-day mortality after VA-ECMO implantation. The secondary endpoint was successful myocardial recovery, transition to durable mechanical circulatory support (MCS), or heart transplantation. Results: After propensity score matching, prophylactic unloading was associated with a significantly lower 30-day mortality risk (risk ratio 0.38, 95% confidence interval 0.23–0.62, and \(\it p\) < 0.001) and a higher probability of myocardial recovery (risk ratio 2.9, 95% confidence interval 1.48–4.54, and \8\it p\) = 0.001) compared with the bail-out strategy. Heart transplantation or durable MCS did not differ significantly between groups. Conclusions: Prophylactic unloading compared with the bail-out strategy may improve clinical outcomes in selected patients on VA-ECMO. Nevertheless, randomized trials are needed to validate these results.
Author: | Darko RadakovicGND, Armin ZittermannORCiDGND, Sebastian Rojas HernandezORCiDGND, Dragan OpacicORCiDGND, Artyom RazumovGND, Emir PrashovikjGND, Henrik FoxORCiDGND, René SchrammORCiDGND, Michiel MorshuisORCiDGND, Volker RudolphORCiDGND, Jan GummertORCiDGND, Christian FlottmannGND, Marcus-André DeutschGND |
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URN: | urn:nbn:de:hbz:294-105538 |
DOI: | https://doi.org/10.3390/life13020582 |
Parent Title (English): | Life |
Subtitle (English): | prophylactic versus bail-out strategy |
Publisher: | MDPI |
Place of publication: | Basel |
Document Type: | Article |
Language: | English |
Date of Publication (online): | 2023/12/22 |
Date of first Publication: | 2023/02/19 |
Publishing Institution: | Ruhr-Universität Bochum, Universitätsbibliothek |
Tag: | Open Access Fonds Impella device; cardiogenic shock; left ventricular unloading; venoarterial extracorporeal membrane oxygenation (VA ECMO) |
Volume: | 13 |
Issue: | 2, Article 582 |
First Page: | 582-1 |
Last Page: | 582-11 |
Note: | Article Processing Charge funded by the Deutsche Forschungsgemeinschaft (DFG) and the Open Access Publication Fund of Ruhr-Universität Bochum. |
Institutes/Facilities: | Herz- und Diabeteszentrum NRW |
Herz- und Diabeteszentrum NRW, Klinik für Thorax- und Kardiovaskularchirurgie | |
Dewey Decimal Classification: | Technik, Medizin, angewandte Wissenschaften / Medizin, Gesundheit |
open_access (DINI-Set): | open_access |
Licence (English): | Creative Commons - CC BY 4.0 - Attribution 4.0 International |