Evidence map›Paper›PMID 32485030›Full record

ArticleJournal of cardiac surgery2020

Left ventricle unloading strategies in ECMO: A single-center experience.

Laura M Piechura, Antonio Coppolino, Gita N Mody, Daniel E Rinewalt, Mohammed Keshk, Mitsugu Ogawa, Raghu Seethala, Erin A Bohula, David A Morrow, Steve K Singh and 2 more

Abstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of cardiac surgery, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
10citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

10 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Review
  4. Review
  5. Article
  6. Article
  7. Review
  8. Venting during venoarterial extracorporeal membrane oxygenation.Clinical research in cardiology : official journal of the German Cardiac Society · 2023
    Review
  9. Article
  10. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Laura M PiechuraDivision of Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Antonio CoppolinoDivision of Thoracic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Gita N ModyDivision of Cardiothoracic Surgery, Department of Surgery, University of North Carolina, Chapel Hill, North Carolina.
Daniel E RinewaltDivision of Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Mohammed KeshkDivision of Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Mitsugu OgawaDivision of Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Raghu SeethalaDivision of Emergency Critical Care Medicine, Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Erin A BohulaDivision of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
David A MorrowDivision of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Steve K SinghRegional Cardiac Health Program, Trillium Health Partners, Ontario, Mississauga, Canada.
Hari R MallidiDivision of Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Steven P KellerDivision of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.ORCID http://orcid.org/0000-0002-3870-9811

Funding

Functional restoration of ventriculo-arterial coupling in cardiogenic shock via dual mechanical supportK08HL143342 · NHLBI · JOHNS HOPKINS UNIVERSITY · PI KELLER, STEVEN PAUL · 2018 to 2023
$853k
NHLBI NIH HHS 5K08HL143342-02NHLBI NIH HHS K08 HL143342
6 · The paper itself

Abstract

introductionExtracorporeal membrane oxygenation (ECMO) is a life-saving technology capable of restoring perfusion but is not without significant complications that limit its realizable therapeutic benefit. ECMO-induced hemodynamics increase cardiac afterload risking left ventricular distention and impaired cardiac recovery. To mitigate potentially harmful effects, multiple strategies to unload the left ventricle (LV) are used in clinical practice but data supporting the optimal approach is presently lacking. MATERIALS &

methodsWe reviewed outcomes of our ECMO population from September 2015 through January 2019 to determine if our LV unloading strategies were associated with patient outcomes. We compared reactive (Group 1, n = 30) versus immediate (Group 2, n = 33) LV unloading and then compared patients unloaded with an Impella CP (n = 19) versus an intra-aortic balloon pump (IABP, n = 16), analyzing survival and ECMO-related complications.

resultsSurvival was similar between Groups 1 and 2 (33 vs 42%, P = .426) with Group 2 experiencing more clinically-significant hemorrhage (40 vs. 67%, P = .034). Survival and ECMO-related complications were similar between patients unloaded with an Impella versus an IABP. However, the Impella group exhibited a higher rate of survival (37%) than predicted by their median SAVE score (18%). DISCUSSION: Based on this analysis, reactive unloading appears to be a viable strategy while venting with the Impella CP provides better than anticipated survival. Our findings correlate with recent large cohort studies and motivate further work to design clinical guidelines and future trial design.

Indexed as

Heart-Assist DevicesIntra-Aortic Balloon PumpingAgedExtracorporeal Membrane OxygenationFemaleHemodynamicsHumansMaleMiddle AgedRetrospective StudiesSurvival RateTreatment OutcomeVentricular Dysfunction, Leftcardiogenic shockextracorporeal membrane oxygenationintraaortic balloon pumpingventricular assist device

Identifiers

PMID32485030
PMCPMC7357854

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.