Timing of active left ventricular unloading in patients on venoarterial extracorporeal membrane oxygenation therapy
Abstract
Background: 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).
Objectives: This study sought to evaluate the association between timing of active LV unloading and implantation of VA-ECMO with outcomes of patients with CS.
Methods: 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.
Results: 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.
Conclusions: 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.
Trial registration: ClinicalTrials.gov NCT05577195.
Author
Schrage, Benedikt
Sundermeyer, Jonas
Blankenberg, Stefan
Colson, Pascal
Eckner, Dennis
Eden, Matthias
Eitel, Ingo
Frank, Derk
Frey, Norbert
Graf, Tobias
Kirchhof, Paulus
Kupka, Danny
Landmesser, Ulf
Linke, Axel
Majunke, Nicolas
Mangner, Norman
Maniuc, Octavian
Mierke, Johannes
Möbius-Winkler, Sven
Morrow, David A
Mourad, Marc
Nordbeck, Peter
Orban, Martin
Pappalardo, Federico
Patel, Sandeep M
Pauschinger, Matthias
Pazzanese, Vittorio
Radakovic, Darko
Schulze, P Christian
Scherer, Clemens
Schwinger, Robert H G
Skurk, Carsten
Thiele, Holger
Varshney, Anubodh
Wechsler, Lukas
Westermann, Dirk
Sundermeyer, Jonas
Blankenberg, Stefan
Colson, Pascal
Eckner, Dennis
Eden, Matthias
Eitel, Ingo
Frank, Derk
Frey, Norbert
Graf, Tobias
Kirchhof, Paulus
Kupka, Danny
Landmesser, Ulf
Linke, Axel
Majunke, Nicolas
Mangner, Norman
Maniuc, Octavian
Mierke, Johannes
Möbius-Winkler, Sven
Morrow, David A
Mourad, Marc
Nordbeck, Peter
Orban, Martin
Pappalardo, Federico
Patel, Sandeep M
Pauschinger, Matthias
Pazzanese, Vittorio
Radakovic, Darko
Schulze, P Christian
Scherer, Clemens
Schwinger, Robert H G
Skurk, Carsten
Thiele, Holger
Varshney, Anubodh
Wechsler, Lukas
Westermann, Dirk
Citations
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Date
2023-01-11
Type
Article
Subject
Anaesthesia, Intensive care, Oncology. Pathology., Haematology
Collections
Citation
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 DA, Mourad M, Nordbeck P, Orban M, Pappalardo F, Patel SM, Pauschinger M, Pazzanese V, Radakovic D, Schulze PC, Scherer C, Schwinger RHG, Skurk C, Thiele H, Varshney A, Wechsler L, Westermann D. Timing of Active Left Ventricular Unloading in Patients on Venoarterial Extracorporeal Membrane Oxygenation Therapy. JACC Heart Fail. 2023 Mar;11(3):321-330. doi: 10.1016/j.jchf.2022.11.005. Epub 2023 Jan 11
Journal / Source Title
JACC: Heart Failure
DOI
10.1016/j.jchf.2022.11.005
PMID
36724180
Publisher
Elsevier
Publisher’s URL
http://www.sciencedirect.com/science/journal/22131779