{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T04:53:24Z","timestamp":1791003204169,"version":"4.1.0"},"reference-count":22,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T00:00:00Z","timestamp":1790899200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T00:00:00Z","timestamp":1790899200000},"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"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Refractory cardiogenic shock remains associated with high mortality despite macrocirculatory stabilization with V\u2010A ECMO. We investigated the association between initial ECMO flow\u2010index, organ dysfunction, inflammatory activation, hemolysis, and clinical outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In this retrospective single\u2010center study, 553 patients receiving V\u2010A ECMO between 2014 and 2024 were divided into low\u2010flow (&lt;\u20091.63\u2009L\/min\/m\n                      <jats:sup>2<\/jats:sup>\n                      ,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009269) and high\u2010flow (\u2265\u20091.63\u2009L\/min\/m\n                      <jats:sup>2<\/jats:sup>\n                      ,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009284) groups. Patients were additionally stratified according to eCPR status. Multivariable logistic regression was used to assess factors associated with multi\u2010organ failure (MOF), and exploratory mediation analyses evaluated day\u20101 free hemoglobin and IL\u20106 as potential mediators.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      High\u2010flow patients were more hemodynamically compromised, with higher lactate, vasoactive\u2010inotropic support, inflammatory markers, and early hemolysis. After exclusion of cerebral death, MOF occurred more frequently in the high\u2010flow group (32.7% vs. 23.0%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.028). Initial flow\u2010index remained independently associated with MOF in the overall cohort (OR 1.102 per 0.1\u2009L\/min\/m\n                      <jats:sup>2<\/jats:sup>\n                      , 95% CI 1.001\u20131.214,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.048) and in the eCPR subgroup (OR 1.117, 95% CI 1.028\u20131.214,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.008). Day\u20101 free hemoglobin was independently associated with MOF, and mediation analysis demonstrated a significant indirect effect through early hemolysis. No significant indirect effect through IL\u20106 was observed. Higher flow index was also associated with worse neurological outcome and reduced survival.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Higher initial V\u2010A ECMO flow\u2010index is associated with greater shock severity and multi\u2010organ failure. Early hemolysis may partly contribute to this association, particularly in eCPR patients. These findings support individualized flow management with close monitoring of hemolysis and evolving organ dysfunction.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/aor.70257","type":"journal-article","created":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T04:19:54Z","timestamp":1791001194000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Initial V\u2010A\n                    <scp>ECMO<\/scp>\n                    Flow\u2010Index and Its Association With Inflammation, Organ Failure, and Outcomes"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2103-9903","authenticated-orcid":false,"given":"Kostiantyn","family":"Kozakov","sequence":"first","affiliation":[{"name":"Department of Cardiothoracic Surgery University Medical Center Regensburg  Regensburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zdenek","family":"Provaznik","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery University Medical Center Regensburg  Regensburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alois","family":"Philipp","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery University Medical Center Regensburg  Regensburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maik","family":"Foltan","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery University Medical Center Regensburg  Regensburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Schach","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II University Medical Center Regensburg  Regensburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergey","family":"Vasin","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery University Medical Center Regensburg  Regensburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Keyser","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery University Medical Center Regensburg  Regensburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leopold","family":"Rupprecht","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery University Medical Center Regensburg  Regensburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christof","family":"Schmid","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery University Medical Center Regensburg  Regensburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Schopka","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery University Medical Center Regensburg  Regensburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,2]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/aor.13331"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2307227"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMc2312854"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13613\u2010022\u201001067\u20109"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.xjon.2024.06.001"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/aor.14272"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ccc.2011.05.006"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfs375"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2016.12.003"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2018.12.019"},{"key":"e_1_2_10_12_1","unstructured":"\u201cELSO 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