Investigation of the potential prognostic role of non-invasive myocardial work in patients receiving veno-arterial extracorporeal membrane oxygenation therapy.

The study aims to examine the prognostic role of non-invasive myocardial work in veno-arterial extracorporeal membrane oxygenation therapy patients. Subjects with cardiogenic shock regardless of etiology will be enrolled 48-72 hours after the initiation of mechanical circulatory support. It is hypothesized that non-invasive myocardial work may be an independent prognosticator of the outcome.

Inclusion Criteria:

• 18 years or older age
• Severe cardiogenic shock requiring the initiation of VA-ECMO therapy
• Stabile hemodynamic state and oxigenation with VA-ECMO and vasoactive support
• Informed written consent (due to the nature of the study, from a legally eligible relative of the patient)

Exclusion Criteria:

• Younger than 18 years of age
• Unstable hemodynamic state or suboptimal oxigenation despite established VA-ECMO and vasoactive support
• Severe neurological damage or confirmed brain death at the time of enrollment which squarely indicates therapy limitation and poor short-term outcome
• Transesophageal echocardiography is contraindicated
• Suboptimal echocardiographic window

Altogether 100 cardiogenic shock patients receiving veno-arterial extracorporeal membrane oxygenation therapy will be enrolled regardless the etiology. Both peripherially and centrally cannulated patients are eligible. Considering that the two populations are typically quite different in terms of indication for the therapy (ACS- or decompensated chronic heart failure-associated CS vs. cardiac surgery population), a balanced enrollment of the two methods will be facilitated. All LV venting options are eligible for enrollment, however, if utilized, the mode of LV unloading (central left atrial vent, Impella, transaortic LV pigtail catheter etc.) will also be collected.