Timing of Active Left Ventricular Unloading in Patients on Venoarterial Extracorporeal Membrane Oxygenation Therapy
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Timing of Active Left Ventricular Unloading in Patients on Venoarterial Extracorporeal Membrane Oxygenation Therapy. / 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.
in: JACC-HEART FAIL, Jahrgang 11, Nr. 3, 03.2023, S. 321-330.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Timing of Active Left Ventricular Unloading in Patients on Venoarterial Extracorporeal Membrane Oxygenation Therapy
AU - Schrage, Benedikt
AU - Sundermeyer, Jonas
AU - Blankenberg, Stefan
AU - Colson, Pascal
AU - Eckner, Dennis
AU - Eden, Matthias
AU - Eitel, Ingo
AU - Frank, Derk
AU - Frey, Norbert
AU - Graf, Tobias
AU - Kirchhof, Paulus
AU - Kupka, Danny
AU - Landmesser, Ulf
AU - Linke, Axel
AU - Majunke, Nicolas
AU - Mangner, Norman
AU - Maniuc, Octavian
AU - Mierke, Johannes
AU - Möbius-Winkler, Sven
AU - Morrow, David A
AU - Mourad, Marc
AU - Nordbeck, Peter
AU - Orban, Martin
AU - Pappalardo, Federico
AU - Patel, Sandeep M
AU - Pauschinger, Matthias
AU - Pazzanese, Vittorio
AU - Radakovic, Darko
AU - Schulze, P Christian
AU - Scherer, Clemens
AU - Schwinger, Robert H G
AU - Skurk, Carsten
AU - Thiele, Holger
AU - Varshney, Anubodh
AU - Wechsler, Lukas
AU - Westermann, Dirk
N1 - Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
PY - 2023/3
Y1 - 2023/3
N2 - 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.
AB - 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.
U2 - 10.1016/j.jchf.2022.11.005
DO - 10.1016/j.jchf.2022.11.005
M3 - SCORING: Journal article
C2 - 36724180
VL - 11
SP - 321
EP - 330
JO - JACC-HEART FAIL
JF - JACC-HEART FAIL
SN - 2213-1779
IS - 3
ER -