Early Intra-aortic Balloon Pump Use After Venoarterial Extracorporeal Membrane Oxygenation

The role of IABP combined with VA-ECMO in patients with CS remains unclear. Therefore, investigators will conduct a prospective randomized clinical trial to explore the effect of early IABP use for LV unloading after VA-ECMO on outcomes in patients with CS. Investigators will randomly assign 358 patients receiving peripheral VA-ECMO to the ECMO+IABP group (n=179) or the ECMO group (n=179). The primary end point was the 30-day mortality.

Inclusion criteria

• Age of ≥18
• Cardiogenic shock(defined as a systolic blood pressure of less than 90 mm Hg for more than 30 minutes or the initiation of catecholamines to maintain a systolic pressure of more than 90 mm Hg, an arterial lactate level of more than 3 mmol per liter, and signs of impaired organ perfusion)
• Successful implantation of VA-ECMO
• Informed consent

Exclusion criteria

• SCAI shock stage A or B
• Presence of moderate to severe aortic insufficiency or aortic dissection
• Severe peripheral vascular disease
• Post-cardiotomy cardiogenic shock(non-CABG procedure) or bridging to cardiac procedure(heart transplantation or LVAD).
• VA-ECMO for definite non-cardiac causes
• Isolated right ventricular failure
• V-A ECMO usage confined to the period during surgery or other interventions
• Ischemic mechanical complications(eg Ventricular septal defect, papillary muscle rupture)
• Extracorporeal cardiopulmonary resuscitation
• LVAD, Impella or IABP in situ.
• Severe bleeding
• Terminal malignancy
• Irreversible neurologic injury
• Pregnancy or lactation