{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T11:15:32Z","timestamp":1788779732244,"version":"build-2803163510"},"reference-count":17,"publisher":"Walter de Gruyter GmbH","issue":"7","license":[{"start":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T00:00:00Z","timestamp":1767916800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,24]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"j_jom-2025-0145_abs_001\">\n                    <jats:title>Context<\/jats:title>\n                    <jats:p>Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a life-sustaining therapy for severe refractory cardiogenic shock. Although VA-ECMO provides various degrees of cardiopulmonary support, mortality rates remain high. Serum biomarkers have potential to identify the rising risk of mortality in patients receiving ECMO, but evidence supporting their prognostic value is inconsistent.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_jom-2025-0145_abs_002\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study aims to systematically investigate existing evidence on the relationship between biomarkers and mortality in adult patients with refractory cardiogenic shock undergoing VA-ECMO support.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_jom-2025-0145_abs_003\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic review was conducted conforming to the Preferred Reporting Items for Systematic Reviews and Meta\u2010Analyses (PRISMA) 2020 guidelines. Analogous search strings were developed to complete a comprehensive literature search across multiple databases that included Embase, Scopus, PubMed, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Search limits include studies published in the last 5\u00a0years (&gt;2018) and in the English language. The inclusion criteria were: all genders aged 18 and older being treated for cardiogenic shock with VA-ECMO and intra-ECMO biomarker data with corresponding mortality data. Biomarkers included in the criteria were: lactate, creatinine, bilirubin, aspartate transaminase (AST), alanine transaminase (ALT), troponin, C-reactive protein (CRP), and white blood cell (WBC) count. Identified articles were included within the main findings after unanimous approval by all authors. The quality of the evidence was assessed systematically utilizing a standardized and validated checklist.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_jom-2025-0145_abs_004\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Our search yielded 1,033 studies, with 650 studies remaining after the removal of duplicates, leaving 538 studies to be screened for title and abstract study relevance. Subsequently, 112 studies remained for full-text review. Reasons for exclusion during full-text review include conference abstract, no mention of specific biomarkers, and wrong comparison of treatment modalities. Five studies remained for data extraction. Data gathered from five retrospective cohort studies reported a total of 589 patients supported by VA-ECMO following a diagnosis of cardiogenic shock, with the most common inciting factor being postcardiac surgery. Most patients were male. The age range for all participants was between 45 and 77\u00a0years. Common comorbidities include diabetes mellitus, hypertension, and vascular disease. Overall mortality was 59.9\u202f% (353\/589) based on survival to 30-day post-ECMO initiation or hospital discharge. In three of the studies, the patients in the survivor cohort had statistically significant lower intra-ECMO lactate levels compared to the non-survivors (p&lt;0.01). One of the studies found statistically significant differences between survivors and non-survivors in the intra-ECMO values for serum lactate (p&lt;0.001), creatinine (p&lt;0.023), bilirubin (p&lt;0.001), AST (p&lt;0.05), and ALT (p&lt;0.05). Another study reported statistically significant differences in nadir lactate levels through 24 and 48\u202fh of ECMO initiation in survivors vs. non-survivors (p=0.001 and p=0.001 respectively).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_jom-2025-0145_abs_005\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Serum lactate was the biomarker most utilized to assess the risk of mortality. Serum creatinine (Scr), bilirubin, AST, and ALT also demonstrated significance in predicting mortality, although not as widely studied as serum lactate. Future research is needed to further investigate the usage of Scr, bilirubin, AST, and ALT to better assess their significance, regarding VA-ECMO mortality in patients diagnosed with cardiogenic shock. Further research is also warranted to investigate the minimal concentration of these biomarkers and their association with mortality to allow clinicians a better predictor of a patient\u2019s mortality risk while receiving VA-ECMO.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1515\/jom-2025-0145","type":"journal-article","created":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T16:22:27Z","timestamp":1767889347000},"page":"305-312","source":"Crossref","is-referenced-by-count":2,"title":["Investigating biomarkers associated with mortality in patients receiving VA-ECMO for cardiogenic shock: a systematic review"],"prefix":"10.1515","volume":"126","author":[{"given":"James","family":"Ramsarran","sequence":"first","affiliation":[{"name":"Medical Students , Philadelphia College of Osteopathic Medicine , Philadelphia , PA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Albertson","sequence":"additional","affiliation":[{"name":"Medical Students , Philadelphia College of Osteopathic Medicine , Philadelphia , PA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tyler","family":"Hoops","sequence":"additional","affiliation":[{"name":"Medical Students , Philadelphia College of Osteopathic Medicine , Philadelphia , PA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darsh","family":"Patel","sequence":"additional","affiliation":[{"name":"Internal Medicine Resident , Mercy Fitzgerald , Darby , PA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas N.","family":"Christy","sequence":"additional","affiliation":[{"name":"Medical Students , Philadelphia College of Osteopathic Medicine , Philadelphia , PA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Joyner","sequence":"additional","affiliation":[{"name":"Director of the Richard A. Henson Research Institute, TidalHealth , Salisbury , MD , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2026,1,9]]},"reference":[{"key":"2026062413492853233_j_jom-2025-0145_ref_001","doi-asserted-by":"crossref","unstructured":"Lorusso, R, Shekar, K, MacLaren, G, Schmidt, M, Pellegrino, V, Meyns, B, et al.. ELSO interim guidelines for venoarterial extracorporeal membrane oxygenation in adult cardiac patients. ASAIO J 2021;67:827\u201344. https:\/\/doi.org\/10.1097\/MAT.0000000000001479.","DOI":"10.1097\/MAT.0000000000001510"},{"key":"2026062413492853233_j_jom-2025-0145_ref_002","doi-asserted-by":"crossref","unstructured":"Abrams, D, Combes, A, Brodie, D. Extracorporeal membrane oxygenation in cardiopulmonary disease in adults. J\u00a0Am Coll Cardiol 2014;63:2769\u201378. https:\/\/doi.org\/10.1016\/j.jacc.2014.03.046.","DOI":"10.1016\/j.jacc.2014.03.046"},{"key":"2026062413492853233_j_jom-2025-0145_ref_003","doi-asserted-by":"crossref","unstructured":"Saeed, O, Danner, J, Lohr, L, Singh, R, Sarswat, N, Mendirichaga, R, et al.. Outcomes and complications associated with extracorporeal membrane oxygenation in adult patients with cardiogenic shock: a review. J\u00a0Am Coll Cardiol 2022;79:676\u201392. https:\/\/doi.org\/10.1016\/j.jacc.2021.12.012.","DOI":"10.1016\/j.jacc.2021.12.012"},{"key":"2026062413492853233_j_jom-2025-0145_ref_004","unstructured":"Schmidt, M, Hajage, D, Lebreton, G, Br\u00e9chot, N, Combes, A. Extracorporeal membrane oxygenation for refractory cardiogenic shock: a retrospective multicenter study of 646 patients. Intensive Care Med 2015;41:1866\u201374. https:\/\/doi.org\/10.1007\/s00134-015-3931-z."},{"key":"2026062413492853233_j_jom-2025-0145_ref_005","doi-asserted-by":"crossref","unstructured":"Keebler, ME, Haddad, EV, Choi, CW, McGrane, S, Zalawadiya, S, Schlendorf, KH, et al.. Venoarterial extracorporeal membrane oxygenation in cardiogenic shock. JACC Heart Fail 2018;6:503\u201316. https:\/\/doi.org\/10.1016\/j.jchf.2018.03.002.","DOI":"10.1016\/j.jchf.2017.11.017"},{"key":"2026062413492853233_j_jom-2025-0145_ref_006","unstructured":"J\u00e4ntti, H, Tarvasm\u00e4ki, T, Harjola, VP, Kivikko, M, Kuitunen, A, Suojaranta-Ylinen, R, et al.. Prognostic value of blood lactate and central venous oxygen saturation in patients treated with extracorporeal membrane oxygenation for cardiogenic shock. Perfusion 2021;36:50\u20137. https:\/\/doi.org\/10.1177\/0267659120986354."},{"key":"2026062413492853233_j_jom-2025-0145_ref_007","doi-asserted-by":"crossref","unstructured":"Rastan, AJ, Dege, A, Mohr, M, Doll, N, Falk, V, Walther, T, et al.. Early and late outcomes of 517 consecutive adult patients treated with extracorporeal membrane oxygenation for refractory postcardiotomy cardiogenic shock. J\u00a0Thorac Cardiovasc Surg 2010;139:302\u201311.e1. https:\/\/doi.org\/10.1016\/j.jtcvs.2009.10.043.","DOI":"10.1016\/j.jtcvs.2009.10.043"},{"key":"2026062413492853233_j_jom-2025-0145_ref_008","unstructured":"Lee, SH, Lee, H, Kim, DH, Kim, J, Kim, JS, Kim, YJ, et al.. Prognostic implications of procalcitonin and C-reactive protein in patients receiving venoarterial extracorporeal membrane oxygenation. Sci Rep 2021;11:9785. https:\/\/doi.org\/10.1038\/s41598-021-89140-0."},{"key":"2026062413492853233_j_jom-2025-0145_ref_009","doi-asserted-by":"crossref","unstructured":"Schmidt, M, Burrell, A, Roberts, L, Bailey, M, Sheldrake, J, Rycus, PT, et al.. Predicting survival after ECMO for refractory cardiogenic shock: the survival after veno-arterial-ECMO (SAVE) score. Eur Heart J 2015;36:2246\u201356. https:\/\/doi.org\/10.1093\/eurheartj\/ehv194.","DOI":"10.1093\/eurheartj\/ehv194"},{"key":"2026062413492853233_j_jom-2025-0145_ref_010","doi-asserted-by":"crossref","unstructured":"Page, M, McKenzie, J, Bossuyt, PM, Boutron, I, Hoffmann, TC, Mulrow, CD, et al.. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:1\u20139. https:\/\/doi.org\/10.1136\/bmj.n71.","DOI":"10.1136\/bmj.n71"},{"key":"2026062413492853233_j_jom-2025-0145_ref_011","doi-asserted-by":"crossref","unstructured":"Schmidt, M, Burrell, A, Roberts, L, Bailey, M, Sheldrake, J, Rycus, PT, et al.. Predicting survival after ECMO for refractory cardiogenic shock: the survival after veno-arterial-ECMO (SAVE)-score. Eur Heart J 2015;36:2246\u201356. https:\/\/doi.org\/10.1093\/eurheartj\/ehv194.","DOI":"10.1093\/eurheartj\/ehv194"},{"key":"2026062413492853233_j_jom-2025-0145_ref_012","doi-asserted-by":"crossref","unstructured":"Downs, SH, Black, N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J\u00a0Epidemiol Community Health 1998;52:377\u201384. https:\/\/doi.org\/10.1136\/jech.52.6.377.","DOI":"10.1136\/jech.52.6.377"},{"key":"2026062413492853233_j_jom-2025-0145_ref_013","doi-asserted-by":"crossref","unstructured":"Ding, X, Xie, H, Yang, F, Wang, L, Hou, X. Risk factors of acute renal injury and in-hospital mortality in adult patients with postcardiotomy cardiogenic shock requiring veno-arterial extracorporeal membrane oxygenation: utility of MELD-XI score. Perfusion 2022;37:505\u201314. https:\/\/doi.org\/10.1177\/02676591211006619.","DOI":"10.1177\/02676591211006619"},{"key":"2026062413492853233_j_jom-2025-0145_ref_014","doi-asserted-by":"crossref","unstructured":"Djordjevic, I, Eghbalzadeh, K, Sabashnikov, A, Deppe, AC, Kuhn, EW, Seo, J, et al.. Single center experience with patients on veno-arterial ECMO due to postcardiotomy right ventricular failure. J\u00a0Card Surg 2020;35:83\u20138. https:\/\/doi.org\/10.1111\/jocs.14332.","DOI":"10.1111\/jocs.14332"},{"key":"2026062413492853233_j_jom-2025-0145_ref_015","doi-asserted-by":"crossref","unstructured":"Hu, RTC, Broad, JD, Osawa, EA, Ancona, P, Iguchi, Y, Miles, LF, et al.. 30-day outcomes post veno-arterial extracorporeal membrane oxygenation (VA-ECMO) after cardiac surgery and predictors of survival. Heart Lung Circ 2020;29:1217\u201325. https:\/\/doi.org\/10.1016\/j.hlc.2020.01.009.","DOI":"10.1016\/j.hlc.2020.01.009"},{"key":"2026062413492853233_j_jom-2025-0145_ref_016","doi-asserted-by":"crossref","unstructured":"Laimoud, M, Machado, P, Lo, MG, Maghirang, MJ, Hakami, E, Qureshi, R. The absolute lactate levels versus clearance for prognostication of post\u2010cardiotomy patients on veno\u2010arterial ECMO. ESC Heart Fail 2024;11:3511\u201322. https:\/\/doi.org\/10.1002\/ehf2.14910.","DOI":"10.1002\/ehf2.14910"},{"key":"2026062413492853233_j_jom-2025-0145_ref_017","doi-asserted-by":"crossref","unstructured":"Porto, I, Mattesini, A, D\u2019Amario, D, Sorini Dini, C, Della Bona, R, Scicchitano, M, et al.. Blood lactate predicts survival after percutaneous implantation of extracorporeal life support for refractory cardiac arrest or cardiogenic shock complicating acute coronary syndrome: insights from the CareGem Registry. Intern Emerg Med 2021;16:463\u201370. https:\/\/doi.org\/10.1007\/s11739-020-02459-0.","DOI":"10.1007\/s11739-020-02459-0"}],"container-title":["Journal of Osteopathic Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/jom-2025-0145\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/jom-2025-0145\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T13:50:54Z","timestamp":1782309054000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/jom-2025-0145\/html"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,9]]},"references-count":17,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,6,25]]},"published-print":{"date-parts":[[2026,6,24]]}},"alternative-id":["10.1515\/jom-2025-0145"],"URL":"https:\/\/doi.org\/10.1515\/jom-2025-0145","relation":{},"ISSN":["2702-3648"],"issn-type":[{"value":"2702-3648","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,9]]}}}