Observational studyCirculation2020
Left Ventricular Unloading Is Associated With Lower Mortality in Patients With Cardiogenic Shock Treated With Venoarterial Extracorporeal Membrane Oxygenation: Results From an International, Multicenter Cohort Study.
2 registry-linked trialsAbstract readMulticenter StudyObservational Study
In one paragraph
Observational study in Circulation, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 222 papers, 7 of them syntheses that pooled it.
0numbers the graph read from it
0cells of the map it votes in
222citing papers in PubMed, 7 pooled it
–field-weighted citation impact
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.
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.
Randomized Embedded Multifactorial Adaptive Platform in ExtraCorporeal Membrane Oxygenation (REMAP ECMO) - Left Ventricular Unloading Study
A Multicentric Left Ventricular Venting Strategy Comparison in Patients Receiving Venoarterial Extracorporeal Life Support
Who cites it
222 citing papers in PubMed, 7 syntheses or guidelines pooled it.
- Impact of left ventricular unloading timing on clinical outcomes in venoarterial extracorporeal membrane oxygenation: an updated systematic review and meta-analysis.BMC cardiovascular disorders · 2025Pooled it
- Left ventricular decompression in paediatric veno-arterial extracorporeal life support: Reviewing the evidence.ESC heart failure · 2025Pooled it
- Sex differences in treatments and outcomes of patients with cardiogenic shock: a systematic review and epidemiological meta-analysis.Critical care (London, England) · 2024Pooled it
- Effects of levosimendan on the outcome of veno-arterial extracorporeal membrane oxygenation: a systematic review and meta-analysis.Clinical research in cardiology : official journal of the German Cardiac Society · 2024Pooled it
- Short-Term Mortality Among Pediatric Patients With Heart Diseases Undergoing Veno-Arterial Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-Analysis.Journal of the American Heart Association · 2023Pooled it
- Predictors of Mortality in Patients Treated with Veno-Arterial ECMO for Cardiogenic Shock Complicating Acute Myocardial Infarction: a Systematic Review and Meta-Analysis.Journal of cardiovascular translational research · 2022Pooled it
- Mortality in cardiogenic shock patients receiving mechanical circulatory support: a network meta-analysis.BMC cardiovascular disorders · 2022Pooled it
- Impella Versus Selective Biatrial Canulation for Left Ventricular Unloading During Extracorporeal Membrane Oxygenation.Cardiovascular therapeutics · 2026Trial
- Combined veno-venous ECMO and direct aortic impella 5.5 support enabling emergency mitral valve replacement in acute severe mitral regurgitation with fulminant pulmonary edema.Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs · 2026Article
- Temporary Mechanical Circulatory Support in Patients in Cardiogenic Shock Requiring Cardiac Surgery: Protected Cardiac Surgery Concept.Journal of clinical medicine · 2026Review
- Left ventricular unloading during VA-ECMO for refractory cardiogenic shock: a target trial emulation multicenter analysis.Critical care (London, England) · 2026Article
- Axial Flow Percutaneous Ventricular Assist Devices: Physiology, Procedural Considerations, and Clinical Applications-A State-of-the-Art Review.Structural heart : the journal of the Heart Team · 2026Review
- Integrating bibliometric analysis and external validation of the SAVE score in VA-ECMO for refractory cardiogenic shock: insights from global trends and the MIMIC-IV database.Journal of thoracic disease · 2026Article
- Gastrointestinal bleeding in patients on venoarterial extracorporeal membrane oxygenation: a multicenter observational study.BMC gastroenterology · 2026Observational
- Phenotyping hemodynamic response to veno-arterial extracorporeal membrane oxygenation in cardiogenic shock.Physiological reports · 2026Article
- Coronary Artery Bypass Grafting Under ECPELLA Support After Out-of-Hospital Cardiac Arrest: A Case Report.Clinical case reports · 2026Article
- Extracorporeal Membrane Oxygenation in Refractory Cardiac Arrest: Current Evidence, Clinical Pathways and Future Directions.Life (Basel, Switzerland) · 2026Review
- Prone Positioning During ECPELLA Support for Cardiogenic Shock: A Single-Center Retrospective Study.Journal of clinical medicine · 2026Article
- Splanchnic ultrasound to guide unloading in VA-ECMO.The ultrasound journal · 2026Article
- Novel treatment strategies in cardiogenic shock: an update on ongoing clinical trials.Heart failure reviews · 2026Review
162 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
49 authors.
Benedikt SchrageDepartments of Cardiology (B.S., P.M.B., S. Blankenberg, S.D., A.G., P.K., D.W.), University Heart and Vascular Center Hamburg, Germany.
Peter Moritz BecherDepartments of Cardiology (B.S., P.M.B., S. Blankenberg, S.D., A.G., P.K., D.W.), University Heart and Vascular Center Hamburg, Germany.
Alexander BernhardtCardiothoracic Surgery (A.B., H.R.), University Heart and Vascular Center Hamburg, Germany.
Hiram BezerraTampa General Hospital, University of South Florida (H.B.).
Stefan BlankenbergDepartments of Cardiology (B.S., P.M.B., S. Blankenberg, S.D., A.G., P.K., D.W.), University Heart and Vascular Center Hamburg, Germany.
Stefan BrunnerMedizinische Klinik und Poliklinik I (S. Brunner, D.K., M.O.), LMU Klinikum, Munich, Germany.
Pascal ColsonDepartment of Anesthesiology and Critical Care Medicine, CHU Montpellier, University Montpellier, France (P.C., M.M.).
Gaston Cudemus DesedaDivision of Anesthesia, Critical Care and Pain Medicine (G.C.D.), Massachusetts General Hospital, Boston.
Salim DabbouraDepartments of Cardiology (B.S., P.M.B., S. Blankenberg, S.D., A.G., P.K., D.W.), University Heart and Vascular Center Hamburg, Germany.
Dennis EcknerDepartment of Cardiology, Paracelsus Medical University Nürnberg, Germany (D.E., M.P.).
Matthias EdenGerman Center for Cardiovascular Research (DZHK), partner site Hamburg/Lübeck/Kiel, Germany (B.S., P.M.B., A.B., S. Blankenberg, S.D., M.E., I.E., D.F., N.F., T.G., P.K., C.N., D.W.).
Ingo EitelGerman Center for Cardiovascular Research (DZHK), partner site Hamburg/Lübeck/Kiel, Germany (B.S., P.M.B., A.B., S. Blankenberg, S.D., M.E., I.E., D.F., N.F., T.G., P.K., C.N., D.W.).
Derk FrankGerman Center for Cardiovascular Research (DZHK), partner site Hamburg/Lübeck/Kiel, Germany (B.S., P.M.B., A.B., S. Blankenberg, S.D., M.E., I.E., D.F., N.F., T.G., P.K., C.N., D.W.).
Norbert FreyGerman Center for Cardiovascular Research (DZHK), partner site Hamburg/Lübeck/Kiel, Germany (B.S., P.M.B., A.B., S. Blankenberg, S.D., M.E., I.E., D.F., N.F., T.G., P.K., C.N., D.W.).
Masaki FunamotoDivision of Cardiac Surgery (M.F., D.M.), Massachusetts General Hospital, Boston.
Alina GoßlingDepartments of Cardiology (B.S., P.M.B., S. Blankenberg, S.D., A.G., P.K., D.W.), University Heart and Vascular Center Hamburg, Germany.
Tobias GrafGerman Center for Cardiovascular Research (DZHK), partner site Hamburg/Lübeck/Kiel, Germany (B.S., P.M.B., A.B., S. Blankenberg, S.D., M.E., I.E., D.F., N.F., T.G., P.K., C.N., D.W.).
Christian HaglHerzchirurgische Klinik und Poliklinik (C.H.), LMU Klinikum, Munich, Germany.
Paulus KirchhofDepartments of Cardiology (B.S., P.M.B., S. Blankenberg, S.D., A.G., P.K., D.W.), University Heart and Vascular Center Hamburg, Germany.
Danny KupkaDepartments of Cardiology (B.S., P.M.B., S. Blankenberg, S.D., A.G., P.K., D.W.), University Heart and Vascular Center Hamburg, Germany.
Ulf LandmesserDepartment of Cardiology, Campus Benjamin, Charité Universitätsmedizin Berlin, Germany (U.L., C.S.).
Jerry LipinskiDepartment of Internal Medicine, University of California, San Diego (J.L.).
Mathew LopesCardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.L., D.A.M., A.V.).
Nicolas MajunkeDepartment of Internal Medicine and Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Germany (N.M., M.S., L.S., H.T., F.T.).
Octavian ManiucMedizinische Klinik und Poliklinik I (S. Brunner, D.K., M.O.), LMU Klinikum, Munich, Germany.
Daniel McGrathDivision of Cardiac Surgery (M.F., D.M.), Massachusetts General Hospital, Boston.
Sven Möbius-WinklerDepartment of Internal Medicine I, University Hospital Jena, Germany (S.M.-W., P.C.S.).
David A MorrowCardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.L., D.A.M., A.V.).
Marc MouradDepartment of Anesthesiology and Critical Care Medicine, CHU Montpellier, University Montpellier, France (P.C., M.M.).
Curt NoelGerman Center for Cardiovascular Research (DZHK), partner site Hamburg/Lübeck/Kiel, Germany (B.S., P.M.B., A.B., S. Blankenberg, S.D., M.E., I.E., D.F., N.F., T.G., P.K., C.N., D.W.).
Peter NordbeckDepartment of Internal Medicine I, University Hospital Würzburg, Germany (O.M., P.N.).
Martin Orban
Federico PappalardoAdvanced Heart Failure and Mechanical Circulatory Support Program, Vita Salute University, Milan, Italy (F.P., V.P.).
Sandeep M PatelDepartment of Interventional Cardiology, St. Rita's Medical Center, Lima, OH (S.M.P.).
Matthias PauschingerDepartment of Cardiology, Paracelsus Medical University Nürnberg, Germany (D.E., M.P.).
Vittorio PazzaneseAdvanced Heart Failure and Mechanical Circulatory Support Program, Vita Salute University, Milan, Italy (F.P., V.P.).
Hermann ReichenspurnerCardiothoracic Surgery (A.B., H.R.), University Heart and Vascular Center Hamburg, Germany.
Marcus SandriDepartment of Internal Medicine and Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Germany (N.M., M.S., L.S., H.T., F.T.).
P Christian SchulzeDepartment of Internal Medicine I, University Hospital Jena, Germany (S.M.-W., P.C.S.).
Robert H G SchwingerMedizinische Klinik II, Klinikum Weiden, Germany (R.H.G.S., L.W.).
Jan-Malte SinningUniversity Heart Center Bonn, Department of Cardiology, Germany (J.-M.S., A.A.).
Adem AksoyUniversity Heart Center Bonn, Department of Cardiology, Germany (J.-M.S., A.A.).
Carsten SkurkDepartment of Cardiology, Campus Benjamin, Charité Universitätsmedizin Berlin, Germany (U.L., C.S.).
Lukasz SzczanowiczDepartment of Internal Medicine and Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Germany (N.M., M.S., L.S., H.T., F.T.).
Holger ThieleDepartment of Internal Medicine and Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Germany (N.M., M.S., L.S., H.T., F.T.).
Franziska TietzDepartment of Internal Medicine and Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Germany (N.M., M.S., L.S., H.T., F.T.).
Anubodh VarshneyCardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.L., D.A.M., A.V.).
Lukas WechslerMedizinische Klinik II, Klinikum Weiden, Germany (R.H.G.S., L.W.).
Dirk WestermannGerman Center for Cardiovascular Research (DZHK), partner site Hamburg/Lübeck/Kiel, Germany (B.S., P.M.B., A.B., S. Blankenberg, S.D., M.E., I.E., D.F., N.F., T.G., P.K., C.N., D.W.).
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundVenoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used to treat cardiogenic shock. However, VA-ECMO might hamper myocardial recovery. The Impella unloads the left ventricle. This study aimed to evaluate whether left ventricular unloading in patients with cardiogenic shock treated with VA-ECMO was associated with lower mortality.
methodsData from 686 consecutive patients with cardiogenic shock treated with VA-ECMO with or without left ventricular unloading using an Impella at 16 tertiary care centers in 4 countries were collected. The association between left ventricular unloading and 30-day mortality was assessed by Cox regression models in a 1:1 propensity score-matched cohort.
resultsLeft ventricular unloading was used in 337 of the 686 patients (49%). After matching, 255 patients with left ventricular unloading were compared with 255 patients without left ventricular unloading. In the matched cohort, left ventricular unloading was associated with lower 30-day mortality (hazard ratio, 0.79 [95% CI, 0.63-0.98];
conclusionsIn this international, multicenter cohort study, left ventricular unloading was associated with lower mortality in patients with cardiogenic shock treated with VA-ECMO, despite higher complication rates. These findings support use of left ventricular unloading in patients with cardiogenic shock treated with VA-ECMO and call for further validation, ideally in a randomized, controlled trial.
Indexed as
InternationalityAdultAgedCohort StudiesExtracorporeal Membrane OxygenationFemaleHumansMaleMiddle AgedMortalityShock, CardiogenicTreatment OutcomeVentricular Function, Leftextracorporeal membrane oxygenationshock, cardiogenic
Identifiers
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LicenceCC BY
Read underepoch 390
Registered trials
NCT05913622ClinicalTrials.gov
NCT06766006ClinicalTrials.gov
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.