Early Preventive Left Ventricle Unloading After VA-ECMO for Refractory Cardiogenic Shock

"An Intraortic balloon pump will be systematically inserted as soon as possible, within 12 hours post-randomization.~* A pulmonary artery catheter (PAC) will enable hemodynamic monitoring of cardiac filling pressures, cardiac output and pulmonary artery pressures.~* Doppler Echocardiography will be performed at least daily to monitor LV ejection, LV dimension, appearance of LV blood stagnation, aortic time-velocity integral (VTI) and aortic valve opening.~* Escalation to a microaxial LV venting pump, central ECMO or atrial septostomy will be possible and discussed by the Shock team (as suggested by international recommendations) in case of~* Overt cardiogenic pulmonary edema requiring invasive mechanical ventilation~* Persisting more than 6 hours despite IABP support and optimization of patient's management (titration of ECMO blood flow, inotropes, non-invasive mechanical ventilation with PEEP, diuretics or hemofiltration)."