PMID- 37642192 OWN - NLM STAT- MEDLINE DCOM- 20231216 LR - 20231218 IS - 1879-0844 (Electronic) IS - 1388-9842 (Linking) VI - 25 IP - 11 DP - 2023 Nov TI - Early left atrial venting versus conventional treatment for left ventricular decompression during venoarterial extracorporeal membrane oxygenation support: The EVOLVE-ECMO randomized clinical trial. PG - 2037-2046 LID - 10.1002/ejhf.3014 [doi] AB - AIMS: Few studies have reported data on the optimal timing of left ventricular (LV) unloading during venoarterial extracorporeal membrane oxygenation (VA-ECMO) for cardiac arrest or shock. This study evaluated the feasibility of an early LV unloading strategy compared with a conventional strategy in VA-ECMO. METHODS AND RESULTS: Between December 2018 and August 2022, 60 patients at two institutions were randomized in a 1:1 ratio to receive early (n = 30) or conventional (n = 30) LV unloading strategies. The early LV unloading strategy was defined as LV unloading performed at the time of VA-ECMO insertion. LV unloading was performed using a percutaneous transseptal left atrial cannulation via the femoral vein incorporated into the ECMO venous circuit. The early and conventional LV unloading groups included 29 (96.7%) and 23 (76.7%) patients, respectively (median time from VA-ECMO insertion to LV unloading: 48.4 h, interquartile range 47.8-96.5 h). The groups showed no significant differences in the rate of VA-ECMO weaning as the primary endpoint (70.0% vs. 76.7%; relative risk 0.91; 95% confidence interval 0.67-1.24; p = 0.386) and survival to discharge (53.3% vs. 50.0%, p = 0.796). However, the pulmonary congestion score index at 48 h after LV unloading was significantly improved only in the early LV unloading group (2.0 +/- 0.7 vs. 1.7 +/- 0.6 at baseline vs. at 48 h; p = 0.008). CONCLUSIONS: Compared with the conventional approach, early LV unloading did not improve the VA-ECMO weaning rate, despite the rapid improvement in pulmonary congestion. Therefore, the results of this study do not support the application of this strategy after VA-ECMO insertion. CI - (c) 2023 European Society of Cardiology. FAU - Park, Hanbit AU - Park H AD - Division of Cardiology, Department of Internal Medicine, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, Republic of Korea. AD - Division of Cardiology, Department of Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, South Korea. FAU - Yang, Jeong Hoon AU - Yang JH AD - Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. FAU - Ahn, Jung-Min AU - Ahn JM AD - Division of Cardiology, Department of Internal Medicine, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, Republic of Korea. FAU - Kang, Do-Yoon AU - Kang DY AD - Division of Cardiology, Department of Internal Medicine, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, Republic of Korea. FAU - Lee, Pil Hyung AU - Lee PH AD - Division of Cardiology, Department of Internal Medicine, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, Republic of Korea. FAU - Kim, Tae Oh AU - Kim TO AD - Division of Cardiology, Department of Internal Medicine, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, Republic of Korea. FAU - Choi, Ki Hong AU - Choi KH AD - Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. FAU - Kang, Pil Je AU - Kang PJ AD - Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. FAU - Jung, Sung-Ho AU - Jung SH AD - Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. FAU - Yun, Sung-Cheol AU - Yun SC AD - Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. FAU - Park, Duk-Woo AU - Park DW AD - Division of Cardiology, Department of Internal Medicine, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, Republic of Korea. FAU - Lee, Seung-Whan AU - Lee SW AD - Division of Cardiology, Department of Internal Medicine, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, Republic of Korea. FAU - Park, Seung-Jung AU - Park SJ AD - Division of Cardiology, Department of Internal Medicine, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, Republic of Korea. FAU - Kim, Min-Seok AU - Kim MS AUID- ORCID: 0000-0003-0860-3650 AD - Division of Cardiology, Department of Internal Medicine, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, Republic of Korea. LA - eng GR - 2018IT0646/Asan Institute for Life Sciences, Asan Medical Center/ PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't DEP - 20230906 PL - England TA - Eur J Heart Fail JT - European journal of heart failure JID - 100887595 SB - IM CIN - Eur J Heart Fail. 2023 Nov;25(11):2047-2049. PMID: 37771278 MH - Humans MH - *Heart Failure/therapy MH - Shock, Cardiogenic/etiology/therapy MH - *Extracorporeal Membrane Oxygenation/methods MH - Heart Atria MH - *Pulmonary Edema MH - Decompression OTO - NOTNLM OT - Cardiogenic shock OT - Catheters OT - Extracorporeal membrane oxygenation OT - Heart transplantation OT - Pulmonary oedema EDAT- 2023/08/29 12:43 MHDA- 2023/12/17 09:44 CRDT- 2023/08/29 06:54 PHST- 2023/08/21 00:00 [revised] PHST- 2023/05/11 00:00 [received] PHST- 2023/08/22 00:00 [accepted] PHST- 2023/12/17 09:44 [medline] PHST- 2023/08/29 12:43 [pubmed] PHST- 2023/08/29 06:54 [entrez] AID - 10.1002/ejhf.3014 [doi] PST - ppublish SO - Eur J Heart Fail. 2023 Nov;25(11):2037-2046. doi: 10.1002/ejhf.3014. Epub 2023 Sep 6.