{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T15:18:07Z","timestamp":1792682287719,"version":"4.5.0"},"reference-count":60,"publisher":"Oxford University Press (OUP)","issue":"38","license":[{"start":{"date-parts":[[2020,10,7]],"date-time":"2020-10-07T00:00:00Z","timestamp":1602028800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,10,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Cardiogenic shock is still a major driver of mortality on intensive care units and complicates \u223c10% of acute coronary syndromes with contemporary mortality rates up to 50%. In the meantime, percutaneous circulatory support devices, in particular venoarterial extracorporeal membrane oxygenation (VA-ECMO), have emerged as an established salvage intervention for patients in cardiogenic shock. Venoarterial extracorporeal membrane oxygenation provides temporary circulatory support until other treatments are effective and enables recovery or serves as a bridge to ventricular assist devices, heart transplantation, or decision-making. In this critical care perspective, we provide a concise overview of VA-ECMO utilization in cardiogenic shock, considering rationale, critical care management, as well as weaning aspects. We supplement previous literature by focusing on therapeutic issues related to the vicious circle of retrograde aortic VA-ECMO flow, increased left ventricular (LV) afterload, insufficient LV unloading, and severe pulmonary congestion limiting prognosis in a relevant proportion of patients receiving VA-ECMO treatment. We will outline different modifications in percutaneous mechanical circulatory support to meet this challenge. Besides a strategy of running ECMO at lowest possible flow rates, novel therapeutic options including the combination of VA-ECMO with percutaneous microaxial pumps or implementation of a venoarteriovenous-ECMO configuration based on an additional venous cannula supplying towards pulmonary circulation are most promising among LV unloading and venting strategies. The latter may even combine the advantages of venovenous and venoarterial ECMO therapy, providing potent respiratory and circulatory support at the same time. However, whether VA-ECMO can reduce mortality has to be evaluated in the urgently needed, ongoing prospective randomized studies EURO-SHOCK (NCT03813134), ANCHOR (NCT04184635), and ECLS-SHOCK (NCT03637205). These studies will provide the opportunity to investigate indication, mode, and effect of LV unloading in dedicated sub-analyses. In future, the Heart Teams should aim at conducting a dedicated randomized trial comparing VA-ECMO support with vs. without LV unloading strategies in patients with cardiogenic shock.<\/jats:p>","DOI":"10.1093\/eurheartj\/ehaa547","type":"journal-article","created":{"date-parts":[[2020,6,15]],"date-time":"2020-06-15T19:11:33Z","timestamp":1592248293000},"page":"3753-3761","source":"Crossref","is-referenced-by-count":80,"title":["Prevention and treatment of pulmonary congestion in patients undergoing venoarterial extracorporeal membrane oxygenation for cardiogenic shock"],"prefix":"10.1093","volume":"41","author":[{"given":"Enzo","family":"L\u00fcsebrink","sequence":"first","affiliation":[{"name":"Intensive Care Unit, Medizinische Klinik und Poliklinik I, Klinikum der Universit\u00e4t M\u00fcnchen, Marchioninistra\u00dfe 15, 81377 Munich, Germany"},{"name":"DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Medizinische Klinik und Poliklinik I, Klinikum der Universit\u00e4t M\u00fcnchen , Marchioninistra\u00dfe 15, 81377 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9830-1941","authenticated-orcid":false,"given":"Mathias","family":"Orban","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Medizinische Klinik und Poliklinik I, Klinikum der Universit\u00e4t M\u00fcnchen, Marchioninistra\u00dfe 15, 81377 Munich, Germany"},{"name":"DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Medizinische Klinik und Poliklinik I, Klinikum der Universit\u00e4t M\u00fcnchen , Marchioninistra\u00dfe 15, 81377 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danny","family":"Kupka","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Medizinische Klinik und Poliklinik I, Klinikum der Universit\u00e4t M\u00fcnchen, Marchioninistra\u00dfe 15, 81377 Munich, Germany"},{"name":"DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Medizinische Klinik und Poliklinik I, Klinikum der Universit\u00e4t M\u00fcnchen , Marchioninistra\u00dfe 15, 81377 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2816-6793","authenticated-orcid":false,"given":"Clemens","family":"Scherer","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Medizinische Klinik und Poliklinik I, Klinikum der Universit\u00e4t M\u00fcnchen, Marchioninistra\u00dfe 15, 81377 Munich, Germany"},{"name":"DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Medizinische Klinik und Poliklinik I, Klinikum der Universit\u00e4t M\u00fcnchen , Marchioninistra\u00dfe 15, 81377 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Hagl","sequence":"additional","affiliation":[{"name":"Herzchirurgische Klinik und Poliklinik, Klinikum der Universit\u00e4t M\u00fcnchen , Marchioninistra\u00dfe 15, 81377 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1531-2088","authenticated-orcid":false,"given":"Sebastian","family":"Zimmer","sequence":"additional","affiliation":[{"name":"Medizinische Klinik und Poliklinik II, Universit\u00e4tsklinikum Bonn , Sigmund-Freud-Stra\u00dfe 25, 53127 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Luedike","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen , Hufelandstra\u00dfe 55, 45122 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0169-998X","authenticated-orcid":false,"given":"Holger","family":"Thiele","sequence":"additional","affiliation":[{"name":"Heart Center Leipzig at University of Leipzig, Department of Internal Medicine\/Cardiology , Leipzig Heart Institute, Str\u00fcmpellstra\u00dfe 39, 04289 Leipzig, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dirk","family":"Westermann","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Allgemeine und Interventionelle Kardiologie, Universit\u00e4tsklinikum Hamburg-Eppendorf , Martinistra\u00dfe 52, 20251 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steffen","family":"Massberg","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Medizinische Klinik und Poliklinik I, Klinikum der Universit\u00e4t M\u00fcnchen, Marchioninistra\u00dfe 15, 81377 Munich, Germany"},{"name":"DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Medizinische Klinik und Poliklinik I, Klinikum der Universit\u00e4t M\u00fcnchen , Marchioninistra\u00dfe 15, 81377 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Sch\u00e4fer","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Kardiologie und Angiologie, Medizinische Hochschule Hannover , Carl-Neuberg-Stra\u00dfe 1, 30625 Hannover, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Orban","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Medizinische Klinik und Poliklinik I, Klinikum der Universit\u00e4t M\u00fcnchen, Marchioninistra\u00dfe 15, 81377 Munich, Germany"},{"name":"DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Medizinische Klinik und Poliklinik I, Klinikum der Universit\u00e4t M\u00fcnchen , Marchioninistra\u00dfe 15, 81377 Munich, 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