{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T09:07:22Z","timestamp":1785575242345,"version":"3.56.0"},"reference-count":21,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2021,12,28]],"date-time":"2021-12-28T00:00:00Z","timestamp":1640649600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and objectives: Extracorporeal life support (ECLS) is a widely accepted and effective strategy for use in patients presenting with refractory cardiogenic shock. Implantation in awake and non-intubated patients allows for optimized evaluation of further therapy options while avoiding potential side effects associated with the need for sedation and intubation. The aim of the study was the assessment of safety and feasibility of awake ECLS implementation and of outcomes in patients treated with this concept. Materials and Methods: We retrospectively reviewed the concept of awake ECLS implantation in 16 consecutive patients (mean age 58 \u00b1 8 years; male: 88%; ischemic cardiomyopathy: 50%) from 02\/2017 to 01\/2021. Study endpoints were survival to weaning or bridging to durable support or organ replacement and development of end-organ function and hemodynamic parameters on ECLS. Results: Fourteen patients (88%) were able to be successfully transitioned to definite therapy options. ECLS support stabilized end-organ function, led to a decrease in mean lactate levels (5.3 \u00b1 3.7 mmol\/L at baseline to 1.9 \u00b1 1.3 mmol\/L 12 h after ECLS start; p = 0.01) and improved hemodynamics (median central venous pressure 20 \u00b1 5 mmHg vs. 10 \u00b1 2 mmHg, p = 0.001) over a median duration of two days (1\u20138 days IQR). Two patients (13%) died on ECLS support due to multi-organ dysfunction syndrome. Survival to discharge of initially successfully bridged or weaned patients was 64%. Conclusions: Awake ECLS implantation is feasible and safe with the key advantage of omitting or delaying general anesthesia and intubation, with their associated risks in cardiogenic-shock patients, facilitating further decision making.<\/jats:p>","DOI":"10.3390\/medicina58010043","type":"journal-article","created":{"date-parts":[[2021,12,28]],"date-time":"2021-12-28T01:20:43Z","timestamp":1640654443000},"page":"43","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Awake Implementation of Extracorporeal Life Support in Refractory Cardiogenic Shock"],"prefix":"10.3390","volume":"58","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8601-9989","authenticated-orcid":false,"given":"Julia","family":"Riebandt","sequence":"first","affiliation":[{"name":"Division of Cardiac Surgery, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Haberl","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klaus","family":"Distelmaier","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8297-898X","authenticated-orcid":false,"given":"Martin H.","family":"Bernardi","sequence":"additional","affiliation":[{"name":"Division of Cardiac Thoracic Vascular Anesthesia and Intensive Care Medicine, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9268-2461","authenticated-orcid":false,"given":"Anne-Kristin","family":"Schaefer","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guenther","family":"Laufer","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2185-4895","authenticated-orcid":false,"given":"Daniel","family":"Zimpfer","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2055-8293","authenticated-orcid":false,"given":"Dominik","family":"Wiedemann","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,12,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e001214","DOI":"10.1136\/openhrt-2019-001214","article-title":"Contemporary trends in use of mechanical circulatory support in patients with acute MI and cardiogenic shock","volume":"7","author":"Helgestad","year":"2020","journal-title":"Open Heart"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1370","DOI":"10.1002\/ejhf.1566","article-title":"Temporal trends in incidence and patient characteristics in cardiogenic shock following acute myocardial infarction from 2010 to 2017: A Danish cohort study","volume":"21","author":"Helgestad","year":"2019","journal-title":"Eur. 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Technol."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/58\/1\/43\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:54:31Z","timestamp":1760169271000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/58\/1\/43"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12,28]]},"references-count":21,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2022,1]]}},"alternative-id":["medicina58010043"],"URL":"https:\/\/doi.org\/10.3390\/medicina58010043","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12,28]]}}}