Timing of Active Left Ventricular Unloading in Patients on Venoarterial Extracorporeal Membrane Oxygenation Therapy

Benedikt Schrage*, Jonas Sundermeyer, Stefan Blankenberg, Pascal Colson, Dennis Eckner, Matthias Eden, Ingo Eitel, Derk Frank, Norbert Frey, Tobias Graf, Paulus Kirchhof, Danny Kupka, Ulf Landmesser, Axel Linke, Nicolas Majunke, Norman Mangner, Octavian Maniuc, Johannes Mierke, Sven Möbius-Winkler, David A. MorrowMarc Mourad, Peter Nordbeck, Martin Orban, Federico Pappalardo, Sandeep M. Patel, Matthias Pauschinger, Vittorio Pazzanese, Darko Radakovic, P. Christian Schulze, Clemens Scherer, Robert H.G. Schwinger, Carsten Skurk, Holger Thiele, Anubodh Varshney, Lukas Wechsler, Dirk Westermann*

*Corresponding author for this work
13 Citations (Scopus)


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.

Original languageEnglish
JournalJACC: Heart Failure
Issue number3
Pages (from-to)321-330
Number of pages10
Publication statusPublished - 03.2023

Research Areas and Centers

  • Centers: Cardiological Center Luebeck (UHZL)

DFG Research Classification Scheme

  • 205-12 Cardiology, Angiology

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