Acute cardiac care & resuscitationRandomised controlled trial
Early Left Atrial Venting Versus Conventional Treatment for Left Ventricular Decompression During Venoarterial Extracorporeal Membrane Oxygenation Support: The EVOLVE-ECMO Randomized Clinical Trial
- Randomised controlled trial
- 2 institutions
- 1:1 randomisation
- Randomised December 2018 – August 2022
Authors' conclusion
Compared with the conventional approach, early LV unloading did not improve the VA-ECMO weaning rate, despite the rapid improvement in pulmonary congestion.
Study context
- Population
- Patients on venoarterial extracorporeal membrane oxygenation (VA-ECMO) for cardiac arrest or shock
- Participants
- 60 patients
- Comparison
- Early vs conventional left ventricular (LV) unloading during VA-ECMO
- Earlyn = 30
- Conventionaln = 30reference
- Primary endpoint
- VA-ECMO weaning
Primary result
As reported in the abstract
Relative risk
0.91
95% CI 0.67–1.24
P = 0.386
By group
Early vs Conventional
RR 0.91 (95% CI 0.67–1.24); P = 0.386
Further findings
Survival to discharge
P = 0.796
LV unloading performed
- LV unloading performed — Median time from VA-ECMO insertion to LV unloading
- 48.4 h (IQR 47.8-96.5 h)
Pulmonary congestion score index, Early group (baseline vs 48 h after LV unloading)
- Early: baseline 2.0 ± 0.7 vs 48 h 1.7 ± 0.6 (significant improvement only in the Early group)
- P = 0.008
Original publication
Early Left Atrial Venting Versus Conventional Treatment for Left Ventricular Decompression During Venoarterial Extracorporeal Membrane Oxygenation Support: The EVOLVE-ECMO Randomized Clinical Trial. Eur J Heart Fail. Published 6 September 2023. doi:10.1002/ejhf.3014
Summarised from the published abstract; every number is checked against it