{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T08:31:33Z","timestamp":1787992293359,"version":"build-2784847793"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,8,24]],"date-time":"2021-08-24T00:00:00Z","timestamp":1629763200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:p><jats:bold>Aims:<\/jats:bold> Unclear neurological outcome often precludes severely compromised patients after out-of-hospital cardiac arrest (OHCA) from mechanical circulatory support (MCS), while it may be considered as rescue therapy for patients with refractory cardiogenic shock (rCS) in the absence of OHCA. This analysis sought to investigate the role of left ventricular (LV) unloading in patients with rCS related to acute myocardial infarction (AMI) after OHCA.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> Of 273 consecutive patients receiving microaxial pumps in the Hannover Cardiac Unloading Registry between January 2013 and August 2018, 47 presented with AMI\u2013rCS following successful resuscitation. Subsequently, the patients were compared by propensity score matching to patients with OHCA AMI\u2013rCS without MCS. The patient data for OHCA without LV unloading was available from 280 patients of the Hannover Cooling Registry for the same time period. Furthermore, the patients with OHCA without rCS were compared to the patients with OHCA AMI\u2013rCS and LV unloading.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> In total, 15 OHCA AMI\u2013rCS patients without MCS were matched to patients with AMI\u2013rCS and Impella. Patients without LV support had a higher proportion of a cardiac cause of death (<jats:italic>n<\/jats:italic> = 7 vs. <jats:italic>n<\/jats:italic> = 3; <jats:italic>p<\/jats:italic> = 0.024). LV unloading with Impella counteract rCS status and was associated with a preferable 30-day survival (66.7 vs. 20%, <jats:italic>p<\/jats:italic> = 0.01) and a favorable neurological outcome after 30 days (Cerebral Performance Category \u22642, 47 vs. 27%). Impella support is associated with a higher 30-day survival (odds ratio, 2.67; 95% confidence interval, 1.02\u201313.66).<\/jats:p><jats:p><jats:bold>Conclusion:<\/jats:bold> In patients after OHCA with AMI\u2013rCS, Impella support incorporated in a strict standardized treatment algorithm results in a preferable 30-day survival and counteracts severe rCS status.<\/jats:p>","DOI":"10.3389\/fcvm.2021.704312","type":"journal-article","created":{"date-parts":[[2021,8,24]],"date-time":"2021-08-24T10:08:41Z","timestamp":1629799721000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":12,"title":["Unloading in Refractory Cardiogenic Shock After Out-Of-Hospital Cardiac Arrest Due to Acute Myocardial Infarction\u2014A Propensity Score-Matched Analysis"],"prefix":"10.3389","volume":"8","author":[{"given":"Jan-Thorben","family":"Sieweke","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muharrem","family":"Akin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julian-Arman","family":"Beheshty","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulrike","family":"Flierl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johann","family":"Bauersachs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Sch\u00e4fer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,8,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"200","DOI":"10.1161\/CIRCINTERVENTIONS.109.913665","article-title":"Immediate percutaneous coronary intervention is associated with better survival after out-of-hospital cardiac arrest: insights from the PROCAT (Parisian Region Out of hospital Cardiac ArresT) registry","volume":"3","author":"Dumas","year":"2010","journal-title":"Circ Cardiovasc Interv."},{"key":"B2","doi-asserted-by":"publisher","first-page":"1883","DOI":"10.1161\/CIRCULATIONAHA.114.010633","article-title":"Trends in short- and long-term survival among out-of-hospital cardiac arrest patients alive at hospital arrival","volume":"130","author":"Wong","year":"2014","journal-title":"Circulation."},{"key":"B3","doi-asserted-by":"publisher","first-page":"544","DOI":"10.1002\/ejhf.289","article-title":"Recommendations on pre-hospital & early hospital management of acute heart failure: a consensus paper from the Heart Failure Association of the European Society of Cardiology, the European Society of Emergency Medicine and the Society of Academic Emergency Medicine","volume":"17","author":"Mebazaa","year":"2015","journal-title":"Eur J Heart Fail."},{"key":"B4","doi-asserted-by":"publisher","first-page":"2419","DOI":"10.1056\/NEJMoa1710261","article-title":"PCI strategies in patients with acute myocardial infarction and cardiogenic shock","volume":"377","author":"Thiele","year":"2017","journal-title":"N Engl J Med."},{"key":"B5","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1056\/NEJM199908263410901","article-title":"Early revascularization in acute myocardial infarction complicated by cardiogenic shock. 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