PMID- 36836939
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230301
IS  - 2075-1729 (Print)
IS  - 2075-1729 (Electronic)
IS  - 2075-1729 (Linking)
VI  - 13
IP  - 2
DP  - 2023 Feb 19
TI  - Left Ventricular Unloading in Patients on Venoarterial Extracorporeal Membrane 
      Oxygenation Therapy in Cardiogenic Shock: Prophylactic Versus Bail-Out Strategy.
LID - 10.3390/life13020582 [doi]
LID - 582
AB  - 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 p < 0.001) and a higher probability of 
      myocardial recovery (risk ratio 2.9, 95% confidence interval 1.48-4.54, and 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.
FAU - Radakovic, Darko
AU  - Radakovic D
AD  - Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, 
      Ruhr-University Bochum, 32545 Bad Oeynhausen, Germany.
FAU - Zittermann, Armin
AU  - Zittermann A
AUID- ORCID: 0000-0001-6085-6554
AD  - Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, 
      Ruhr-University Bochum, 32545 Bad Oeynhausen, Germany.
FAU - Rojas, Sebastian V
AU  - Rojas SV
AUID- ORCID: 0000-0002-9505-1358
AD  - Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, 
      Ruhr-University Bochum, 32545 Bad Oeynhausen, Germany.
FAU - Opacic, Dragan
AU  - Opacic D
AUID- ORCID: 0000-0002-0125-7938
AD  - Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, 
      Ruhr-University Bochum, 32545 Bad Oeynhausen, Germany.
FAU - Razumov, Artyom
AU  - Razumov A
AD  - Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, 
      Ruhr-University Bochum, 32545 Bad Oeynhausen, Germany.
FAU - Prashovikj, Emir
AU  - Prashovikj E
AD  - Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, 
      Ruhr-University Bochum, 32545 Bad Oeynhausen, Germany.
FAU - Fox, Henrik
AU  - Fox H
AUID- ORCID: 0000-0002-2187-8715
AD  - Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, 
      Ruhr-University Bochum, 32545 Bad Oeynhausen, Germany.
FAU - Schramm, Rene
AU  - Schramm R
AD  - Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, 
      Ruhr-University Bochum, 32545 Bad Oeynhausen, Germany.
FAU - Morshuis, Michiel
AU  - Morshuis M
AD  - Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, 
      Ruhr-University Bochum, 32545 Bad Oeynhausen, Germany.
FAU - Rudolph, Volker
AU  - Rudolph V
AD  - Clinic for General and Interventional Cardiology/Angiology, Heart and Diabetes 
      Center NRW, Ruhr-University Bochum, 32545 Bad Oeynhausen, Germany.
FAU - Gummert, Jan
AU  - Gummert J
AD  - Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, 
      Ruhr-University Bochum, 32545 Bad Oeynhausen, Germany.
FAU - Flottmann, Christian
AU  - Flottmann C
AD  - Lukas Krankenhaus Bunde Medizinische Klinik II-Innere Medizin und Kardiologie 
      Bunde Germany, 32257 Bunde, Germany.
FAU - Deutsch, Marcus-Andre
AU  - Deutsch MA
AD  - Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, 
      Ruhr-University Bochum, 32545 Bad Oeynhausen, Germany.
LA  - eng
PT  - Journal Article
DEP - 20230219
PL  - Switzerland
TA  - Life (Basel)
JT  - Life (Basel, Switzerland)
JID - 101580444
PMC - PMC9967184
OTO - NOTNLM
OT  - Impella device
OT  - cardiogenic shock
OT  - left ventricular unloading
OT  - venoarterial extracorporeal membrane oxygenation (VA ECMO)
COIS- The authors declare no conflict of interest.
EDAT- 2023/02/26 06:00
MHDA- 2023/02/26 06:01
PMCR- 2023/02/19
CRDT- 2023/02/25 03:22
PHST- 2022/11/28 00:00 [received]
PHST- 2022/12/30 00:00 [revised]
PHST- 2023/02/17 00:00 [accepted]
PHST- 2023/02/25 03:22 [entrez]
PHST- 2023/02/26 06:00 [pubmed]
PHST- 2023/02/26 06:01 [medline]
PHST- 2023/02/19 00:00 [pmc-release]
AID - life13020582 [pii]
AID - life-13-00582 [pii]
AID - 10.3390/life13020582 [doi]
PST - epublish
SO  - Life (Basel). 2023 Feb 19;13(2):582. doi: 10.3390/life13020582.