Evidence map›Paper›PMID 42661221›Full record

ArticleCritical care (London, England)2026

Left ventricular unloading during VA-ECMO for refractory cardiogenic shock: a target trial emulation multicenter analysis.

Angela Dettling, Ouriel Saura, Lisa Dilange, David Levy, Manuela Lucenteforte, Benedikt N Beer, Charles Juvin, Jonas Sundermeyer, Guillaume Hekimian, Marvin Kriz and 8 more

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

Article in Critical care (London, England), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–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

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

18 authors.

Angela Dettling *Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany.
Ouriel Saura *Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Hôpital Pitié-Salpêtrière, 47, bd de l'Hôpital, Paris Cedex 13, 75651, France.
Lisa DilangeDépartement de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Paris, CIC-1421, France.
David LevyService de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Hôpital Pitié-Salpêtrière, 47, bd de l'Hôpital, Paris Cedex 13, 75651, France.
Manuela LucenteforteDepartment of Health Sciences, University of Milan, Milano, Italy.
Benedikt N BeerDepartment of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany.
Charles JuvinInstitute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, Paris, France.
Jonas SundermeyerDepartment of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany.
Guillaume HekimianService de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Hôpital Pitié-Salpêtrière, 47, bd de l'Hôpital, Paris Cedex 13, 75651, France.
Marvin KrizDepartment of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany.
Alexander BernhardtDepartment of Cardiothoracic Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany.
Stefan KlugeDepartment of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Matthieu SchmidtService de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Hôpital Pitié-Salpêtrière, 47, bd de l'Hôpital, Paris Cedex 13, 75651, France.
Pascal LeprinceInstitute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, Paris, France.
Guillaume LebretonInstitute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, Paris, France.
David HajageDépartement de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Paris, CIC-1421, France.
Benedikt Schrage *Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany.
Alain Combes *Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Hôpital Pitié-Salpêtrière, 47, bd de l'Hôpital, Paris Cedex 13, 75651, France. alain.combes@aphp.fr.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundConflicting data exist regarding the survival benefit of mechanical left ventricular (LV) unloading in patients receiving peripheral venoarterial extracorporeal membrane oxygenation (VA-ECMO) for refractory cardiogenic shock (CS). In this study, we aimed to assess the effect of LV unloading (Impella or intra-aortic balloon pump [IABP]) on 60-day mortality in patients with refractory CS treated with VA-ECMO.

methodsWe conducted a retrospective bi-center study including consecutive patients requiring VA-ECMO for ≥ 48 h in two high-volume ECMO centers between 2019 and 2023, using the target trial emulation framework. Patients were classified as receiving VA-ECMO alone or VA-ECMO with LV unloading if the unloading strategy was applied within 24 h after ECMO implantation. Propensity-score overlap weighting was applied to adjust for baseline differences. The primary endpoint was 60-day mortality. Secondary outcomes included ECMO weaning rates and device-related complications.

resultsAmong 264 patients (76% male, mean age 53 ± 14 years), 138 (52.2%) received VA-ECMO alone and 126 (47.8%) underwent LV unloading (78 IABP, 48 Impella), 2 were lost to follow-up. Unloading was not associated with improved 60-day mortality (weighted risk difference: 1.4% [95% CI: -11.8%, 14.6%], p = 0.84). No significant differences were observed in ECMO weaning rates, but device-related complications were more frequent in the unloading group.

conclusionIn this propensity-score weighted analysis, LV unloading during VA-ECMO was not associated with improved survival at 60 days. These hypothesis-generating findings highlight the need for a refined, phenotype-driven approach to patient selection for LV unloading in ECMO-supported cardiogenic shock.

Indexed as

Extracorporeal Membrane OxygenationShock, CardiogenicAdultAgedFemaleHumansIntra-Aortic Balloon PumpingMaleMiddle AgedPropensity ScoreRetrospective StudiesIntra-aortic balloon pump [IABP]Mechanical left ventricular (LV) unloadingMicroaxial flow pumpTarget trial emulation frameworkVenoarterial extracorporeal membrane oxygenation (VA-ECMO)

Identifiers

PMID42661221
PMCPMC13520225

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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.