Left ventricular unloading during venoarterial extracorporeal membrane oxygenation (VA-ECMO) for refractory cardiogenic shock: a target trial emulation multicenter analysis
Main finding · 60-day mortalityResult — go to the resultWeighted risk difference 1.4% 95% CI −11.8% to 14.6%Authors' conclusion
In this propensity-score weighted analysis, LV unloading during VA-ECMO was not associated with improved survival at 60 days.
Study context
- Population
- Consecutive patients requiring VA-ECMO for ≥ 48 h for refractory cardiogenic shock in two high-volume ECMO centers, 2019–20232 lost to follow-up
- Participants
- 264 patients
- Exposure
- VA-ECMO with left ventricular (LV) unloading vs VA-ECMO alone
- Unloadingn = 126
- VA-ECMO alonen = 138reference
- Outcome
- 60-day mortality
- Follow-up
- 60 days
Methodological detailstarget trial emulation, bi-center, propensity-score overlap weighting
- Target trial emulation
- Bi-center
- Propensity-score overlap weighting
Main finding
As reported in the abstract
Weighted risk difference
1.4%
95% CI −11.8% to 14.6%
P = 0.84
Unloading vs VA-ECMO alone
weighted risk difference 1.4% (95% CI −11.8% to 14.6%); P = 0.84
Observational data: associations, not effects.
Secondary outcomes
ECMO weaning rates
- No significant differences
Safety
Device-related complications
- More frequent in the unloading group
Original publication
Left ventricular unloading during VA-ECMO for refractory cardiogenic shock: a target trial emulation multicenter analysis. Crit Care. Published 27 August 2026. doi:10.
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