{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T03:39:13Z","timestamp":1772163553090,"version":"3.50.1"},"reference-count":42,"publisher":"BMJ","issue":"10","license":[{"start":{"date-parts":[[2021,10,19]],"date-time":"2021-10-19T00:00:00Z","timestamp":1634601600000},"content-version":"unspecified","delay-in-days":18,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Innovation Fund Project of Higher Education in Gansu Province","award":["2020B-028"],"award-info":[{"award-number":["2020B-028"]}]},{"name":"Cuiying Scientific and Technological Innovation Program of Lanzhou University Second Hospital","award":["No. CY2017-BJ01"],"award-info":[{"award-number":["No. CY2017-BJ01"]}]},{"name":"Cuiying Scientific and Technological Innovation Program of Lanzhou University Second Hospital","award":["No. CY2017-MS07"],"award-info":[{"award-number":["No. CY2017-MS07"]}]},{"name":"Cuiying Scientific and Technological Innovation Program of Lanzhou University Second Hospital","award":["No. CY2019-QN01"],"award-info":[{"award-number":["No. CY2019-QN01"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2021,9,27]]},"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Venoarterial extracorporeal membrane oxygenation (VA-ECMO) has been widely used for patients with refractory cardiogenic shock. A common side effect of this technic is the resultant increase in left ventricular (LV) afterload which could potentially aggravate myocardial ischaemia, delay ventricular recovery and increase the risk of pulmonary congestion. Several LV unloading strategies have been proposed and implemented to mitigate these complications. However, it is still indistinct that which one is the best choice for clinical application. This Bayesian network meta-analysis (NMA) aims to compare the efficacy of different LV unloading strategies during VA-ECMO.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>PubMed, Embase, the Cochrane Library and the International Clinical Trials Registry Platform will be explored from their inception to 31 December 2020. Random controlled trials and cohort studies that compared different LV unloading strategies during VA-ECMO will be included in this study. The primary outcome will be in-hospital mortality. The secondary outcomes will include neurological complications, haemolysis, bleeding, limb ischaemia, renal failure, gastrointestinal complications, sepsis, duration of mechanical ventilation, length of intensive care unit and hospital stays. Pairwise and NMA will respectively be conducted using Stata (V.16, StataCorp) and Aggregate Data Drug Information System (V.1.16.5), and the cumulative probability will be used to rank the included LV unloading strategies. The risk of bias will be conducted using the Cochrane Collaboration\u2019s tool or Newcastle-Ottawa Quality Assessment Scale according to their study design. Subgroup analysis, sensitivity analysis and publication bias assessment will be performed. The Grading of Recommendations Assessment, Development and Evaluation will be conducted to explore the quality of evidence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>Either ethics approval or patient consent is not necessary, because this study will be based on literature. The results will be disseminated through peer-reviewed publications and conference presentations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PROSPERO registration number<\/jats:title>\n                    <jats:p>CRD42020165093.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2020-047046","type":"journal-article","created":{"date-parts":[[2021,10,19]],"date-time":"2021-10-19T17:33:19Z","timestamp":1634664799000},"page":"e047046","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Efficacy of left ventricular unloading strategies during venoarterial extracorporeal membrane oxygenation in patients with cardiogenic shock: a protocol for a systematic review and Bayesian network meta-analysis"],"prefix":"10.1136","volume":"11","author":[{"given":"Pengbin","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou, Gansu, China"},{"name":"State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shilin","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou, Gansu, China"},{"name":"Laboratory of Extracorporeal Life Support, Lanzhou University Second Hospital, Lanzhou, Gansu, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kerong","family":"Zhai","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou, Gansu, China"},{"name":"Laboratory of Extracorporeal Life Support, Lanzhou University Second Hospital, Lanzhou, Gansu, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jian","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou, Gansu, China"},{"name":"Laboratory of Extracorporeal Life Support, Lanzhou University Second Hospital, Lanzhou, Gansu, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xingdong","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou, Gansu, China"},{"name":"Laboratory of Extracorporeal Life Support, Lanzhou University Second Hospital, Lanzhou, Gansu, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhenze","family":"Tao","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou, Gansu, China"},{"name":"Laboratory of Extracorporeal Life Support, Lanzhou University Second Hospital, Lanzhou, Gansu, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2256-6203","authenticated-orcid":false,"given":"Bingren","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou, Gansu, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1525-7509","authenticated-orcid":false,"given":"Debin","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou, Gansu, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0821-8875","authenticated-orcid":false,"given":"Yongnan","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou, Gansu, China"},{"name":"Laboratory of Extracorporeal Life Support, Lanzhou University Second Hospital, Lanzhou, Gansu, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,10,19]]},"reference":[{"key":"2025120521180200000_11.10.e047046.1","doi-asserted-by":"crossref","first-page":"3839","DOI":"10.1093\/eurheartj\/ehz783","article-title":"Molecular signature of cardiogenic shock","volume":"41","author":"Iborra-Egea","year":"2020","journal-title":"Eur Heart J"},{"key":"2025120521180200000_11.10.e047046.2","doi-asserted-by":"publisher","DOI":"10.1093\/EURHEARTJ\/EHZ363"},{"key":"2025120521180200000_11.10.e047046.3","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehv051"},{"key":"2025120521180200000_11.10.e047046.4","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.106.613596"},{"key":"2025120521180200000_11.10.e047046.5","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/eht248"},{"key":"2025120521180200000_11.10.e047046.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.11.038"},{"key":"2025120521180200000_11.10.e047046.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2014.03.046"},{"key":"2025120521180200000_11.10.e047046.8","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-016-4536-8"},{"key":"2025120521180200000_11.10.e047046.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2016.02.044"},{"key":"2025120521180200000_11.10.e047046.10","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1016\/j.jtcvs.2017.02.055","article-title":"Long-term outcomes of extracorporeal membrane oxygenation support for postcardiotomy shock","volume":"154","author":"Chen","year":"2017","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2025120521180200000_11.10.e047046.11","doi-asserted-by":"publisher","DOI":"10.1097\/MAT.0b013e3182a4b2f6"},{"key":"2025120521180200000_11.10.e047046.12","doi-asserted-by":"crossref","first-page":"1676","DOI":"10.21037\/jtd.2019.03.29","article-title":"Left ventricular distension and venting strategies for patients on venoarterial extracorporeal membrane oxygenation","volume":"11","author":"Cevasco","year":"2019","journal-title":"J Thorac Dis"},{"key":"2025120521180200000_11.10.e047046.13","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1002\/ejhf.695","article-title":"Are two crutches better than one? the ongoing dilemma on the effects and need for left ventricular unloading during veno-arterial extracorporeal membrane oxygenation","volume":"19","author":"Lorusso","year":"2017","journal-title":"Eur J Heart Fail"},{"key":"2025120521180200000_11.10.e047046.14","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1007\/s12265-019-9863-z","article-title":"Beyond reperfusion: acute ventricular unloading and cardioprotection during myocardial infarction","volume":"12","author":"Curran","year":"2019","journal-title":"J Cardiovasc Transl Res"},{"key":"2025120521180200000_11.10.e047046.15","doi-asserted-by":"crossref","first-page":"e459","DOI":"10.1097\/CCM.0000000000002966","article-title":"Nonejecting hearts on femoral veno-arterial extracorporeal membrane oxygenation: aortic root blood stasis and thrombus formation-a case series and review of the literature","volume":"46","author":"Hireche-Chikaoui","year":"2018","journal-title":"Crit Care Med"},{"key":"2025120521180200000_11.10.e047046.16","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1186\/s13054-017-1633-1","article-title":"Duration of veno-arterial extracorporeal life support (Va ECMO) and outcome: an analysis of the extracorporeal life support organization (ELSO) registry","volume":"21","author":"Smith","year":"2017","journal-title":"Crit Care"},{"key":"2025120521180200000_11.10.e047046.17","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1002\/ejhf.850","article-title":"Modalities and effects of left ventricle unloading on extracorporeal life support: a review of the current literature","volume":"19 Suppl 2","author":"Meani","year":"2017","journal-title":"Eur J Heart Fail"},{"key":"2025120521180200000_11.10.e047046.18","doi-asserted-by":"crossref","DOI":"10.3390\/jcm9041039","article-title":"Left ventricle unloading with veno-arterial extracorporeal membrane oxygenation for cardiogenic shock. systematic review and meta-analysis","volume":"9","author":"Kowalewski","year":"2020","journal-title":"J Clin Med"},{"key":"2025120521180200000_11.10.e047046.19","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.10.085"},{"key":"2025120521180200000_11.10.e047046.20","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCHEARTFAILURE.119.006486","article-title":"Optimal strategy and timing of left ventricular Venting during veno-arterial extracorporeal life support for adults in cardiogenic shock: a systematic review and meta-analysis","volume":"12","author":"Al-Fares","year":"2019","journal-title":"Circ Heart Fail"},{"key":"2025120521180200000_11.10.e047046.21","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)61783-3"},{"key":"2025120521180200000_11.10.e047046.22","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1093\/ejcts\/ezy304","article-title":"Effect of an intra-aortic balloon pump with venoarterial extracorporeal membrane oxygenation on mortality of patients with cardiogenic shock: a systematic review and meta-analysis\u2020","volume":"55","author":"Li","year":"2019","journal-title":"Eur J Cardiothorac Surg"},{"key":"2025120521180200000_11.10.e047046.23","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.j3932"},{"key":"2025120521180200000_11.10.e047046.24","doi-asserted-by":"publisher","DOI":"10.7326\/M14-2385"},{"key":"2025120521180200000_11.10.e047046.25","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.f2914"},{"key":"2025120521180200000_11.10.e047046.26","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.g7647"},{"key":"2025120521180200000_11.10.e047046.27","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1000100"},{"key":"2025120521180200000_11.10.e047046.28","doi-asserted-by":"crossref","first-page":"9","DOI":"10.21037\/acs.2018.11.07","article-title":"Left ventricular decompression in veno-arterial extracorporeal membrane oxygenation","volume":"8","author":"Xie","year":"2019","journal-title":"Ann Cardiothorac Surg"},{"key":"2025120521180200000_11.10.e047046.29","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1053\/j.jvca.2019.08.024","article-title":"Strategies for left ventricular decompression during venoarterial extracorporeal membrane oxygenation - a narrative review","volume":"34","author":"Desai","year":"2020","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"2025120521180200000_11.10.e047046.30","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCHEARTFAILURE.118.004905","article-title":"Venoarterial extracorporeal membrane oxygenation for cardiogenic shock and cardiac arrest","volume":"11","author":"Rao","year":"2018","journal-title":"Circ Heart Fail"},{"key":"2025120521180200000_11.10.e047046.31","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2019.03.506"},{"key":"2025120521180200000_11.10.e047046.32","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.d5928"},{"key":"2025120521180200000_11.10.e047046.33","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-010-9491-z"},{"key":"2025120521180200000_11.10.e047046.34","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.327.7414.557"},{"key":"2025120521180200000_11.10.e047046.35","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2010.03.016"},{"key":"2025120521180200000_11.10.e047046.36","doi-asserted-by":"publisher","DOI":"10.1007\/s00296-014-2994-2"},{"key":"2025120521180200000_11.10.e047046.37","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0076654"},{"key":"2025120521180200000_11.10.e047046.38","doi-asserted-by":"publisher","DOI":"10.1002\/jrsm.1045"},{"key":"2025120521180200000_11.10.e047046.39","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.315.7109.629"},{"key":"2025120521180200000_11.10.e047046.40","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2010.04.026"},{"key":"2025120521180200000_11.10.e047046.41","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2015.03.036"},{"key":"2025120521180200000_11.10.e047046.42","doi-asserted-by":"crossref","first-page":"5813","DOI":"10.21037\/jtd.2018.09.119","article-title":"Impact of cannula design on packed red blood cell transfusions: technical advancement to improve outcomes in extracorporeal membrane oxygenation","volume":"10","author":"Martucci","year":"2018","journal-title":"J Thorac Dis"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2020-047046","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T05:18:14Z","timestamp":1764998294000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2020-047046"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10]]},"references-count":42,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2021,10,19]]},"published-print":{"date-parts":[[2021,10]]}},"alternative-id":["10.1136\/bmjopen-2020-047046"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2020-047046","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-58884\/v1","asserted-by":"object"}]},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,10]]}}}