Skip to main content
 
Notice: Users may be experiencing issues with displaying some pages on stanfordhealthcare.org. We are working closely with our technical teams to resolve the issue as quickly as possible. Thank you for your patience.
 

See our updated masking policy »

Stanford Health Care

Timing of Active Left Ventricular Unloading in Patients on Venoarterial Extracorporeal Membrane Oxygenation Therapy. JACC. Heart failure Schrage, B., Sundermeyer, J., Blankenberg, S., Colson, P., Eckner, D., Eden, M., Eitel, I., Frank, D., Frey, N., Graf, T., Kirchhof, P., Kupka, D., Landmesser, U., Linke, A., Majunke, N., Mangner, N., Maniuc, O., Mierke, J., Möbius-Winkler, S., Morrow, D. A., Mourad, M., Nordbeck, P., Orban, M., Pappalardo, F., Patel, S. M., Pauschinger, M., Pazzanese, V., Radakovic, D., Schulze, P. C., Scherer, C., Schwinger, R. H., Skurk, C., Thiele, H., Varshney, A., Wechsler, L., Westermann, D. 2022

Abstract

It is currently unclear if active left ventricular (LV) unloading should be used as a primary treatment strategy or as a bailout in patients with cardiogenic shock (CS) treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO).The study sought to evaluate the association between timing of active LV unloading and implantation of VA-ECMO with outcomes of patients with CS.Data from 421 patients with CS treated with VA-ECMO and active LV unloading at 18 tertiary care centers in 4 countries were analyzed. Patients were stratified by timing of device implantation in early vs delayed active LV unloading (defined by implantation before up to 2 hours after VA-ECMO). Adjusted Cox and logistic regression models were fitted to evaluate the association between early active LV unloading and 30-day mortality as well as successful weaning from ventilation.Overall, 310 (73.6%) patients with CS were treated with early active LV unloading. Early active LV unloading was associated with a lower 30-day mortality risk (HR: 0.64; 95% CI: 0.46-0.88) and a higher likelihood of successful weaning from ventilation (OR: 2.17; 95% CI: 1.19-3.93) but not with more complications. Importantly, the relative mortality risk increased and the likelihood of successful weaning from ventilation decreased almost proportionally with the time interval between VA-ECMO implantation and (delayed) initiation of active LV unloading.This exploratory study lends support to the use of early active LV unloading in CS patients on VA-ECMO, although the findings need to be validated in a randomized controlled trial.

View details for DOI 10.1016/j.jchf.2022.11.005

View details for PubMedID 36724180