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. Morrow; Marc 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

doi:10.1016/j.jchf.2022.11.005

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

Clinic of Internal Medicine II - Cardiology

13 Citations (Scopus)

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.

Original language	English
Journal	JACC: Heart Failure
Volume	11
Issue number	3
Pages (from-to)	321-330
Number of pages	10
ISSN	2213-1779
DOIs	https://doi.org/10.1016/j.jchf.2022.11.005
Publication status	Published - 03.2023

Research Areas and Centers

Centers: Cardiological Center Luebeck (UHZL)

DFG Research Classification Scheme

205-12 Cardiology, Angiology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.jchf.2022.11.005

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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., ... Westermann, D. (2023). Timing of Active Left Ventricular Unloading in Patients on Venoarterial Extracorporeal Membrane Oxygenation Therapy. JACC: Heart Failure, 11(3), 321-330. https://doi.org/10.1016/j.jchf.2022.11.005

@article{2cf8257b44274d60a079c5e72bcd91aa,

title = "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.",

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

year = "2023",

month = mar,

doi = "10.1016/j.jchf.2022.11.005",

language = "English",

volume = "11",

pages = "321--330",

journal = "JACC: Heart Failure",

issn = "2213-1779",

number = "3",

}

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 2023, 'Timing of Active Left Ventricular Unloading in Patients on Venoarterial Extracorporeal Membrane Oxygenation Therapy', JACC: Heart Failure, vol. 11, no. 3, pp. 321-330. https://doi.org/10.1016/j.jchf.2022.11.005

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

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.

UR - http://www.scopus.com/inward/record.url?scp=85148666703&partnerID=8YFLogxK

UR - https://www.mendeley.com/catalogue/a9cc153b-e4b4-3a8f-b35b-217fb2f970a5/

U2 - 10.1016/j.jchf.2022.11.005

DO - 10.1016/j.jchf.2022.11.005

M3 - Journal articles

C2 - 36724180

AN - SCOPUS:85148666703

SN - 2213-1779

VL - 11

SP - 321

EP - 330

JO - JACC: Heart Failure

JF - JACC: Heart Failure

IS - 3

ER -

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

Abstract

Research Areas and Centers

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UN SDGs

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