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After cannulation, vasoplegia and cardiac depression are frequent. In literature, there are conflicting data on inotropic therapy in these patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Analysis of a retrospective registry of all patients treated with VA-ECMO in a university hospital center between October 2010 and December 2018 for cardiogenic shock or extracorporeal cardiopulmonary resuscitation (eCPR) with a focus on individual early inotropic therapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 231 patients (age 58.6\u2009\u00b1\u200914.3, 29.9% female, 58% eCPR, in-house survival 43.7%) were analyzed. Of these, 41.6% received no inotrope therapy within the first 24\u2009h (survival 47.9%), 29.0% received an inodilator (survival 52.2%), and 29.0% received epinephrine (survival 25.0%). Survival of patients with epinephrine was significantly worse compared to other patient groups when evaluating 30-day survival (<jats:italic>p<\/jats:italic>\u2009=\u20090.034\/<jats:italic>p<\/jats:italic>\u2009=\u20090.005) and cumulative incidence of in-hospital death (<jats:italic>p<\/jats:italic>\u2009=\u20090.001). In a multivariate logistic regression analysis, treatment with epinephrine was associated with mortality in the whole cohort (OR 0.38,<jats:italic>p<\/jats:italic>\u2009=\u20090.011) as well as after propensity score matching (OR 0.24,<jats:italic>p<\/jats:italic>\u2009=\u20090.037). We found no significant differences between patients with inodilator treatment and those without.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Early epinephrine therapy within the first 24\u2009h after cannulation for VA-ECMO was associated with poor survival compared to patients with or without any inodilator therapy. Until randomized data are available, epinephrine should be avoided in patients on VA-ECMO.<\/jats:p><\/jats:sec>","DOI":"10.1186\/s13054-019-2605-4","type":"journal-article","created":{"date-parts":[[2019,9,18]],"date-time":"2019-09-18T15:05:17Z","timestamp":1568819117000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":35,"title":["Epinephrine, inodilator, or no inotrope in venoarterial extracorporeal membrane oxygenation implantation: a single-center experience"],"prefix":"10.1186","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1335-4732","authenticated-orcid":false,"given":"Viviane","family":"Zotzmann","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Rilinger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corinna N.","family":"Lang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klaus","family":"Kaier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Benk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Duerschmied","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul M.","family":"Biever","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Bode","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Wengenmayer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dawid L.","family":"Staudacher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2019,9,18]]},"reference":[{"issue":"2","key":"2605_CR1","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1007\/s12471-018-1073-9","volume":"26","author":"C Meuwese","year":"2018","unstructured":"Meuwese C, Ramjankhan F, Braithwaite S, De Jonge N, De Jong M, Buijsrogge M, Janssen J, Kl\u00f6pping C, Kirkels J, Donker D. 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