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Pulmonary congestion and mortality during venoarterial extracorporeal membrane oxygenation (VA-ECMO): does time matter?

Published:December 19, 2020DOI:https://doi.org/10.1016/j.ejim.2020.12.005
      In a recent edition of this Journal, an intriguing study was published which examined the association between (development of) pulmonary congestion (PC) and mortality in patients with post-cardiotomy cardiogenic shock requiring extracorporeal membrane oxygenation (ECMO). [
      • Distelmaier K
      • Wiedemann D
      • Lampichler K
      • Toth D
      • Galli L
      • Haberl T
      • et al.
      Interdependence of VA-ECMO output, pulmonary congestion and outcome after cardiac surgery.
      ] Distelmaier and colleagues observed in 266 patients that presence of PC on days 3 and 5 —but not day 0— after ECMO initiation was negatively associated with survival. We were struck by the apparent disparity in impact of PC on mortality between first and subsequent days. We are concerned that two methodological issues might have caused this apparent difference; selection (survivor) bias and confounding.
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