Early Left Ventricular Unloading Improves Survival in Patients With Cardiogenic Shock Undergoing Extracorporeal Membrane Oxygenation (ECMO)

In their highly ranked published registry study "Timing of Active Left Ventricular Unloading in Patients on Venoarterial Extracorporeal Membrane Oxygenation Therapy" (JACC Heart Fail. 2022 Dec 13; S2213-1779(22)00657-6), the team led by Prof. Dirk Westermann from Freiburg and Dr. Benedikt Schrage from Hamburg investigated the impact of left ventricular unloading using the Impella CP® heart pump on the outcome of patients with cardiogenic shock.

The investigators found that early use of ventricular unloading was crucial for both survival and successful weaning from invasive ventilation. In the group with early active left ventricular unloading, the Impella heart pump was inserted within two hours of the VA ECMO implantation, while the group with delayed active LV unloading received the Impella heart pump between >2 to 24 hours after the VA ECMO implantation. The primary endpoint of the study was 30-day all-cause mortality, and the secondary endpoint was successful weaning from mechanical ventilation. Early active unloading was associated with a 36% lower relative risk of 30-day mortality. Each hour without active unloading was associated with increased mortality and a lower probability of successful weaning from ventilation.

In the interview, Dr. Schrage first discusses the publication by Dr. Jan Behlolavek and, based on this study and his own experiences, addresses the difficulties in patient selection. He then describes the impact of the results of his registry study on the treatment strategy at his own center. Additionally, he introduces the ongoing randomized controlled UNLOAD ECMO study (NCT05577195), which further investigates the effect of early ventricular unloading in cardiogenic shock.