November 29, 2025
Background: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is used for the treatment of cardiogenic shock. Concomitant left ventricular unloading (LVU) with a microaxial flow pump (mAFP) enables myocardial and pulmonary recovery and may overcome some of the limitations of VA-ECMO.
Methods: The study included 145 patients with cardiogenic shock. Of these, 89 (61.4%) were treated with VA-ECMO alone (ECMO group), whereas 56 (38.6%) received LVU with a surgically implanted mAFP in addition to VA-ECMO (ECMELLA group). Outcomes were compared after 2:1 propensity score matching. Subgroup analysis evaluated patients who received mAFP within the first 2 hours after VA-ECMO implantation.
Results: After propensity score matching, 30-day and 1-year survival were similar between the ECMO and ECMELLA groups (p = 0.62 and p = 0.68, respectively). In the subgroup analysis, patients who received mAFP within the first 2 hours after VA-ECMO implantation had improved 30-day survival (hazard ratio [HR]: 0.45; 95% confidence interval [CI]: 0.23-0.88; p = 0.02) and 1-year survival (HR: 0.52; 95% CI: 0.28-0.97; p = 0.04). The rates of limb ischemia, hemorrhage, and renal replacement therapy were comparable between the propensity score-matched cohorts.
Conclusions: Early LVU with a surgically implanted mAFP in patients receiving VA-ECMO improved short-term and long-term survival.
Keywords: cardiogenic shock; extracorporeal membrane oxygenation; extracorporeal life support; microaxial flow pump.
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