?? Paper of the day
Prashant Nasa
Intensivist-Anaesthesiologist II Editor: Rational use of IV Fluids in Critically ll PROVE Network -Delphi Methodology II Fluid and Oxygen are Drugs
Early Left Ventricular Unloading or Conventional Approach After Venoarterial Extracorporeal Membrane Oxygenation: The EARLY-UNLOAD Randomized Clinical Trial
Published in Circulation
Summary:
The article discusses the results of the EARLY-UNLOAD trial, which aimed to compare the efficacy of early routine left ventricular unloading with transseptal left atrial cannulation versus the conventional strategy in patients with cardiogenic shock undergoing venoarterial extracorporeal membrane oxygenation (VA-ECMO).
Half of the patients in the conventional group underwent rescue left ventricular unloading as needed
?? Takeaways:
1?? Early routine left ventricular unloading with transseptal left atrial cannulation did not reduce all-cause death at 30 days compared to the conventional strategy.
2?? Further multicenter trials using other unloading modalities, such as the left-sided Impella device, are needed to investigate the efficacy of early routine left ventricular unloading.
Limitations:
1. The study only focused on using transseptal left atrial cannulation for left ventricular unloading. It did not consider other unloading modalities, which may have different efficacy outcomes.
2. The study did not evaluate the long-term effects of early routine left ventricular unloading. It mainly focused on short-term clinical outcomes, such as all-cause death at 30 days.