{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T06:03:42Z","timestamp":1780553022381,"version":"3.54.1"},"reference-count":25,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T00:00:00Z","timestamp":1773792000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T00:00:00Z","timestamp":1773792000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Artificial Organs"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>To date, no studies have described the financial burden and behaviors of left ventricular mechanical unloading (LVMU) for patients on veno\u2010arterial extracorporeal membrane oxygenation (VA ECMO). Given the uptrending use of VA ECMO, describing its associated costs is essential for its continued uptake.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>We describe the inpatient costs of patients who were managed with ECMO for cardiogenic shock (CS) with and without LVMU.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study of adult (age \u2265\u200918\u2009years) patients who received ECMO at some point during their hospital stay and were nonpostoperative patients (e.g., medical CS) using the IBM MarketScan database. Data were extracted from 1\/1\/2008\u201312\/31\/2021.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Exposures<\/jats:title>\n                    <jats:p>The exposure of interest was the additional use of LVMU (intra\u2010aortic balloon pump, peripherally inserted left ventricular assist device [pVAD], or \u201cother\u201d) added to ECMO. Costs were calculated daily and modeled according to the daily status of ECMO, LVMU, ECMO\u2009+\u2009LVMU, or no device.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>Patient characteristics, including age, sex, and comorbidities quantified using the Charlson Comorbidity Index (CCI), etiology of heart failure (acute myocardial infarction [AMI] vs. chronic heart failure [CHF]), hospital and intensive care unit (ICU) length of stay (LOS), and total inpatient costs, were described using descriptive statistics between groups. The outcomes of interest were total inpatient costs. Secondary outcomes included in\u2010hospital mortality and hospital and intensive care unit (ICU) length of stay (LOS). We stratified patients by receipt of LVMU and used propensity score matching from patient\u2010level characteristics to balance the use of LVMU between groups. Cost outcomes were modeled using mixed effects linear regression clustered on matched groups and reporting incident rate ratios (IRR). LOS and mortality outcomes were modeled using Poisson (IRR) and logistic (adjusted odds ratio [aOR]) regression, respectively, conditional on matched groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Enrolled patients (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20091596) were 56\u2009years old (interquartile range [IQR] 47 to 62), had an ICU LOS of 9 (3 to 19) days, and a hospital length of stay of 18 (7 to 35) days, which were not different between groups. Patients who received LVMU had a higher CCI (\n                      <jats:italic>p\u2009&lt;<\/jats:italic>\n                      \u20090.001), and were more likely to have a primary CS etiology of AMI (54% vs. 39%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) but not CHF (66% vs. 62%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.08). The median total inpatient cost of ECMO alone was $320\u2009269 vs. $390\u2009508 (ECMO\u2009+\u2009LVMU [\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001]). In adjusted analysis, compared to patients without ECMO or LVMU, the daily incurred costs for patients on ECMO alone were three times higher (cost ratio\u2009=\u20093.0,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), 2.6 times higher for patients on LVMU alone (cost ratio\u2009=\u20092.6,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), and 4.2 times higher for people on both ECMO and LVMU (cost ratio\u2009=\u20094.2,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Patients with ECMO\u2009+\u2009LVMU had a longer hospital LOS (IRR 1.059;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) compared to ECMO alone, but a similar hospital ICU LOS (IRR 0.98;\n                      <jats:italic>p\u2009=<\/jats:italic>\n                      \u20090.08). Patients who received LVMU had significantly lower mortality than those who only received ECMO (HR\u2009=\u20090.62,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.006).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>CS patients managed with VA ECMO and LVMU had significantly increased cost, significantly longer LOS, and significantly decreased mortality compared to ECMO alone. Understanding the impact of LVMU on the cost of an ECMO course will aid appropriate resource allocation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/aor.70117","type":"journal-article","created":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T15:50:47Z","timestamp":1773849047000},"page":"917-923","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Hospital Costs Associated With Mechanical Left Ventricular Unloading Devices During\n                    <scp>VA ECMO<\/scp>\n                    for Adult Cardiogenic Shock"],"prefix":"10.1111","volume":"50","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4314-973X","authenticated-orcid":false,"given":"Maxwell A.","family":"Hockstein","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Department of Critical Care Medicine MedStar Washington Hospital Center, Georgetown University School of Medicine  Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua J.","family":"Horns","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Utah Health  Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3096-1227","authenticated-orcid":false,"given":"Thomas","family":"Hanff","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Utah Health  Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0029-5019","authenticated-orcid":false,"given":"Iosif","family":"Taleb","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine University of California San Diego  San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9218-4764","authenticated-orcid":false,"given":"Craig","family":"Selzman","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Utah Health  Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stavros","family":"Drakos","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Utah Health  Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4441-7460","authenticated-orcid":false,"given":"Richard","family":"Nelson","sequence":"additional","affiliation":[{"name":"Division of Epidemiology, Department of Medicine University of Utah Health  Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8879-2628","authenticated-orcid":false,"given":"Joseph E.","family":"Tonna","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine University of California San Diego  San Diego California USA"},{"name":"Division of Cardiothoracic Surgery, Department of Surgery University of Utah Health  Salt Lake City Utah USA"},{"name":"Department of Emergency Medicine University of Utah Health  Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,3,18]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2023-078358"},{"issue":"8","key":"e_1_2_11_3_1","doi-asserted-by":"crossref","DOI":"10.36660\/abc.20230672","article-title":"Custo\u2010Efetividade da Oxigena\u00e7\u00e3o por Membrana Extracorp\u00f3rea Venoarterial no Choque Cardiog\u00eanico Refrat\u00e1rio: Um Estudo na Perspectiva Brasileira","volume":"121","author":"Decker S. 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