{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T15:52:42Z","timestamp":1791301962867,"version":"4.1.0"},"reference-count":30,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2024,2,6]]},"abstract":"<jats:sec sec-type=\"background\" xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Venoarterial extracorporeal membrane oxygenation (ECMO) provides full hemodynamic support for patients with cardiogenic shock, but optimal timing of ECMO initiation remains uncertain. We sought to determine whether earlier initiation of ECMO is associated with improved survival in cardiogenic shock.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods and Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      We analyzed adult patients with cardiogenic shock who received venoarterial ECMO from the international Extracorporeal Life Support Organization (ELSO) registry from 2009 to 2019, excluding those cannulated following an operation. Multivariable logistic regression evaluated the association between time from admission to ECMO initiation and in\u2010hospital death. Among 8619 patients (median, 56.7 [range, 44.8\u201365.6] years; 33.5% women), the median duration from admission to ECMO initiation was 14 (5\u201332) hours. Patients who had ECMO initiated within 24\u2009hours (n=5882 [68.2%]) differed from those who had ECMO initiated after 24\u2009hours, with younger age, more preceding cardiac arrest, and worse acidosis. After multivariable adjustment, patients with ECMO initiated &gt;24\u2009hours after admission had higher risk of in\u2010hospital death (adjusted odds ratio, 1.20 [95% CI, 1.06\u20131.36];\n                      <jats:italic>P<\/jats:italic>\n                      =0.004). Each 12\u2010hour increase in the time from admission to ECMO initiation was incrementally associated with higher adjusted in\u2010hospital mortality rate (adjusted odds ratio, 1.06 [95% CI, 1.03\u20131.10];\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001). The association between longer time to ECMO and worse outcomes appeared stronger in patients with lower shock severity.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Longer delays from admission to ECMO initiation were associated with higher a mortality rate in a large\u2010scale, international registry. Our analysis supports optimization of door\u2010to\u2010support time and the avoidance of inappropriately delayed ECMO initiation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.123.032288","type":"journal-article","created":{"date-parts":[[2024,1,19]],"date-time":"2024-01-19T06:35:21Z","timestamp":1705646121000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":59,"title":["Timing of Initiation of Extracorporeal Membrane Oxygenation Support and Outcomes Among Patients With Cardiogenic Shock"],"prefix":"10.1161","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6366-2859","authenticated-orcid":false,"given":"Jacob C.","family":"Jentzer","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine Mayo Clinic Rochester MN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1223-327X","authenticated-orcid":false,"given":"Stavros G.","family":"Drakos","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine and Nora Eccles Harrison Cardiovascular Research Training Institute University of Utah Salt Lake City UT USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9218-4764","authenticated-orcid":false,"given":"Craig H.","family":"Selzman","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery, Department of Surgery University of Utah Salt Lake City UT USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clark","family":"Owyang","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine New York Presbyterian Hospital\u2010Weill Cornell Medical Center New York NY 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