{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T07:24:44Z","timestamp":1793258684618,"version":"4.5.0"},"reference-count":39,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T00:00:00Z","timestamp":1762905600000},"content-version":"vor","delay-in-days":1097,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2022,11,11]],"date-time":"2022-11-11T00:00:00Z","timestamp":1668124800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000860","name":"European Society of Cardiology","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000860","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000860","name":"European Society of Cardiology","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000860","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,2,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is currently one of the most used devices in refractory cardiogenic shock. However, there is a lack of evidence on how to set the \u2018optimal\u2019 flow. We aimed to describe the evolution of VA-ECMO flows in a cardiogenic shock population and determine the risk factors of \u2018high-ECMO flow\u2019.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>A 7 year database of patients supported with VA-ECMO was used. Based on the median flow during the first 48 h of the VA-ECMO run, patients were classified as \u2018high-flow\u2019 or \u2018low-flow\u2019, respectively, when median ECMO flow was \u22653.6 or &amp;lt;3.6 L\/min. Outcomes included rates of ventilator-associated pneumonia, ECMO-related complications, days on ECMO, days on mechanical ventilation, intensive care unit and hospitalization lengths of stay, and in-hospital and 60 day mortality. Risk factors of high-ECMO flow were assessed using univariate and multivariate cox regression. The study population included 209 patients on VA-ECMO, median age was 51 (40\u201359) years, and 78% were males. The most frequent aetiology leading to cardiogenic shock was end-stage dilated cardiomyopathy (57%), followed by acute myocardial infarction (23%) and fulminant myocarditis (17%). Among the 209 patients, 105 (50%) were classified as \u2018high-flow\u2019. This group had a higher rate of ischaemic aetiology (16% vs. 30%, P = 0.023) and was sicker at admission, in terms of worse Simplified Acute Physiology Score II score [40 (26\u201358) vs. 56 (42\u201374), P &amp;lt; 0.001], higher lactate [3.6 (2.2\u20135.8) mmol\/L vs. 5.2 (3\u20139.7) mmol\/L, P &amp;lt; 0.001], and higher aspartate aminotransferase [97 (41\u2013375) U\/L vs. 309 (85\u2013939) U\/L, P &amp;lt; 0.001], among others. The \u2018low-flow\u2019 group had less ventilator-associated pneumonia (40% vs. 59%, P = 0.007) and less days on mechanical ventilation [4 (1.5\u20137.5) vs. 6 (3\u201312) days, P = 0.009]. No differences were found in lengths of stay or survival according to the ECMO flow. The multivariate analysis showed that risk factors independently associated with \u2018high-flow\u2019 were mechanical ventilation at cannulation [odds ratio (OR) 3.9, 95% confidence interval (CI) 2.1\u20137.1] and pre-ECMO lactate (OR 1.1, 95% CI 1.0\u20131.2).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In patients with refractory cardiogenic shock supported with VA-ECMO, sicker patients had higher support since early phases, presenting thereafter higher rates of ventilator-associated pneumonia but similar survival compared with patients with lower flows.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ehf2.14132","type":"journal-article","created":{"date-parts":[[2022,11,12]],"date-time":"2022-11-12T01:40:03Z","timestamp":1668217203000},"page":"568-577","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Time Course, Factors Related to, and Prognostic Impact of Venoarterial Extracorporeal Membrane Flow in Cardiogenic Shock"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0984-3472","authenticated-orcid":false,"given":"Santiago","family":"Montero","sequence":"first","affiliation":[{"name":"Acute Cardiovascular Care Unit, Cardiology, Hospital Germans Trias i Pujol, Departament de Medicina, Universitat Aut\u00f2noma de Barcelona , Barcelona ,","place":["Spain"]},{"name":"Medical Intensive Care Unit, Assistance Publique\u2013H\u00f4pitaux de Paris, Piti\u00e9\u2013Salp\u00eatri\u00e8re Hospital , Paris Cedex 13 ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mercedes","family":"Rivas-Lasarte","sequence":"additional","affiliation":[{"name":"Advanced Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital Universitario Puerta de Hierro Majadahonda, CIBERCV , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florent","family":"Huang","sequence":"additional","affiliation":[{"name":"Medical Intensive Care Unit, Assistance Publique\u2013H\u00f4pitaux de Paris, Piti\u00e9\u2013Salp\u00eatri\u00e8re Hospital , Paris Cedex 13 ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juliette","family":"Chommeloux","sequence":"additional","affiliation":[{"name":"Medical Intensive Care Unit, Assistance Publique\u2013H\u00f4pitaux de Paris, Piti\u00e9\u2013Salp\u00eatri\u00e8re Hospital , Paris Cedex 13 ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierre","family":"Demondion","sequence":"additional","affiliation":[{"name":"Thoracic and Cardiovascular Department, Assistance Publique\u2013H\u00f4pitaux de Paris, Piti\u00e9\u2013Salp\u00eatri\u00e8re Hospital , Paris Cedex 13 ,","place":["France"]},{"name":"Institute of Cardiometabolism and Nutrition, Sorbonne Universit\u00e9, INSERM UMRS_1166-iCAN , 75651, Paris Cedex 13 ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Br\u00e9chot","sequence":"additional","affiliation":[{"name":"Medical Intensive Care Unit, Assistance Publique\u2013H\u00f4pitaux de Paris, Piti\u00e9\u2013Salp\u00eatri\u00e8re Hospital , Paris Cedex 13 ,","place":["France"]},{"name":"Institute of Cardiometabolism and Nutrition, Sorbonne Universit\u00e9, INSERM UMRS_1166-iCAN , 75651, Paris Cedex 13 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