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Cardiogenic ShockECMO-FLOWNCT06936839

Optimal ECMO Flow in the Critical Phase of Cardiogenic Shock to Optimize Peripheral Organ Perfusion and Myocardial Stress

An observational study of Cardiogenic Shock, run by University Hospital, Montpellier at 1 site in France.

Not yet recruiting

Opening soon. The study is approved but enrolment has not started yet. Sites may already take enquiries.

Sites and contacts
Official record
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Trial summary

Veno-arterial ECMO (VA ECMO) is considered the ultimate lifesaving technique in refractory cardiogenic shock (CS). However, VA ECMO is associated with potentially serious adverse effects and complications. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Cardiogenic Shock
What is being tested?
Obversation
How many people
55 participants
Where
1 siteFrance
Study dates
15 Apr 2025to 1 Apr 2026
Phase
Observational
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Study population: Adult patients with cardiogenic shock treated with VA ECMO for less than 48 hours without any of the exclusion criteria.

Who may be able to join

  • cardiogenic shock
  • treated with VA ECMO for less than 48hours

Who cannot join

  • ECMO initiated for refractory cardiac arrest
  • Cardiac arres prior to the cardiogenic shock with Low-Flow > 30 min
  • Noradrenaline dose > 1μg/kg/min, vasopressin dose > 2IU/h, dobutamine dose > 15μg/kg/min, adrenaline dose > 1μg/kg/min, or unstabilized vasopressors or inotropes
  • Post-cardiotomy cardiogenic shock
  • Septic shock
  • Left ventricular unloading by Impella (CP/5) or atrioseptostomy
Show all 14Show fewer
  • Atrial septal defect
  • Ventricular septal defect
  • Pregnant or breast-feeding women
  • Patients protected by law (under guardianship or curatorship),
  • Patient participating in another research study with an exclusion period still in progress
  • Opposition to participation after having been informed
  • Patient not affiliated to any health care system
  • Patient unable to express non-opposition without available trusted person

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Philippe Gaudard, MD, PhD contact

+33467335958

p-gaudard@chu-montpellier.fr

France1 site
  • Montpellier University Hospital

    Montpellier, Occitanie, 34090

    Aurore Ughetto, MD, +33467335958, a-ughetto@chu-montpellier.fr

Other trials in France

About this study

Veno-arterial ECMO (VA ECMO) is considered the ultimate lifesaving technique in refractory cardiogenic shock (CS). However, VA ECMO is associated with potentially serious adverse effects and complications. Many authors have demonstrated that VA ECMO increases left ventricular (LV) afterload, leading to increased LV stress, left ventricular end-diastolic pressure (LVEDP), and left atrial pressure (LAP). This pressure increase frequently results in pulmonary oedema and higher myocardial oxygen consumption. These complications are critical to patient survival and myocardial recovery and can lead to prolonged hospital stays and increased healthcare costs.

In the absence of clinical studies and strong recommendations, the optimized management of VA ECMO in clinical practice involves finding an ECMO flow that balances adequate organ perfusion with preserved ventricular ejection, while minimizing LV stress. Since the optimal flow changes with myocardial recovery, ramp tests are regularly performed to adjust ECMO flow.

Read more

To date, the optimized management of VA ECMO has been guided empirically. The aim of this study is to describe the consequences of variations in VA ECMO flow during the critical phase of cardiogenic shock on peripheral organ perfusion and LV stress. By analyzing the relationships between VA ECMO flow rate, peripheral perfusion, and myocardial stress, investigators aim to optimize flow settings-particularly by minimizing the potential complications of VA ECMO.

During the daily ramp tests, investigators plan to collect hemodynamic data (cardiac output, SvO₂, pulse pressure, EtCO₂, vasopressor and inotrope dosing), echocardiographic measurements, and organ perfusion indicators (NIRSS, CO₂ gap, respiratory quotient, lactate levels). Data will be collected on Day 1 (ECMO initiation), Day 2 (24 hours after ECMO initiation), and Day 3 (48 hours after ECMO initiation).

Being tested
Obversation
Keywords
ECMO, optimal flow, cardiogenic shock, echocardiography, organ perfusion, myocardial recovery, human, adult, left ventricular overload
Medical subject headings
Shock, Cardiogenic

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • ObversationOther

    Observing the optimal flow rate to reduce left ventricular stress and enhance peripheral organ perfusion during ramp tests (conducted at QECMO levels of 100%, 75%, 50%, and 25%, provided that SVO₂ remains >55% and NIRS rSO₂ remains >50%)

Study groups in NCT06936839
Study groupRoleWhat they receive
study cohortAdult patients at the early phase of a cardiogenic shock treated with veno-arterial ECMO (<48h)
Receives: Other: Obversation

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. optimal flow

    ECMO flow indexed to body surface area, defined as the flow with minimum PCWP (pulmonary capillary wedge pressure) and SvO2>55% at different times after ECMO start (Day 1, day 2 and day 3).

    Measured: Day 1 (ECMO initiation), Day 2 (24 hours after ECMO initiation), and Day 3 (48 hours after ECMO initiation).

Secondary outcomes (5)
  1. optimal flow according to echocardiography

    ECMO flow indexed to body surface area, defined as the flow with minimum LVEDD (Left Ventricular End-Diastolic Diameter) and SvO2>55% at different times after ECMO start (Day 1, day 2 and day 3).

    Measured: Day 1 (ECMO initiation), Day 2 (24 hours after ECMO initiation), and Day 3 (48 hours after ECMO initiation).

  2. optimal flow according to the patient's native cardiac output

    ECMO flow indexed to body surface area, defined as the flow with optimized native cardiac output (measured or estimated by EtCO2 and arterial pulse pressure) at different times after ECMO start (Day 1, day 2 and day 3).

    Measured: Day 1 (ECMO initiation), Day 2 (24 hours after ECMO initiation), and Day 3 (48 hours after ECMO initiation).

  3. optimal flow in subgroup 1 (low pulse pressure)

    Optimal flow as defined by the primary outcome in patients with low arterial pulse pressure (<15mmHg) at different times after ECMO start (Day 1, day 2 and day 3).

    Measured: Day 1 (ECMO initiation), Day 2 (24 hours after ECMO initiation), and Day 3 (48 hours after ECMO initiation).

  4. optimal flow in subgroup 2 (normal pulse pressure)

    Optimal flow as defined by the primary outcome in patients with normal arterial pulse pressure (>15mmHg) at different times after ECMO start (Day 1, day 2 and day 3).

    Measured: Day 1 (ECMO initiation), Day 2 (24 hours after ECMO initiation), and Day 3 (48 hours after ECMO initiation).

  5. Correlation between flow and other perfusion indicators

    test the correlation between flow rate and tissue perfusion indicators (SvO2, NIRSS, Respiratory quotient, CO2 gap).

    Measured: Day 1 (ECMO initiation), Day 2 (24 hours after ECMO initiation), and Day 3 (48 hours after ECMO initiation).

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted20 Apr 2025
  2. Study start15 Apr 2025 (estimated)
  3. Primary completion1 Apr 2026 (estimated)
  4. Study completion1 Apr 2026 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Prospective
Enrolment
55 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06936839
Sponsor's protocol ID
RECHMPL24_0215
Acronym
ECMO-FLOW
Status last verified
Apr 2025
First submitted
26 Mar 2025
Last updated
20 Apr 2025
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Ostadal P, Mlcek M, Kruger A, Hala P, Lacko S, Mates M, Vondrakova D, Svoboda T, Hrachovina M, Janotka M, Psotova H, Strunina S, Kittnar O, Neuzil P. Increasing venoarterial extracorporeal membrane oxygenation flow negatively affects left ventricular performance in a porcine model of cardiogenic shock. J Transl Med. 2015 Aug 15;13:266. doi: 10.1186/s12967-015-0634-6.

    PubMed 26275717
  • Burkhoff D, Sayer G, Doshi D, Uriel N. Hemodynamics of Mechanical Circulatory Support. J Am Coll Cardiol. 2015 Dec 15;66(23):2663-2674. doi: 10.1016/j.jacc.2015.10.017.

    PubMed 26670067
  • Fuhrman BP, Hernan LJ, Rotta AT, Heard CM, Rosenkranz ER. Pathophysiology of cardiac extracorporeal membrane oxygenation. Artif Organs. 1999 Nov;23(11):966-9. doi: 10.1046/j.1525-1594.1999.06484.x.

    PubMed 10564298
  • Burkhoff D, Sagawa K. Ventricular efficiency predicted by an analytical model. Am J Physiol. 1986 Jun;250(6 Pt 2):R1021-7. doi: 10.1152/ajpregu.1986.250.6.R1021.

    PubMed 3717375
  • Mallat J, Pepy F, Lemyze M, Gasan G, Vangrunderbeeck N, Tronchon L, Vallet B, Thevenin D. Central venous-to-arterial carbon dioxide partial pressure difference in early resuscitation from septic shock: a prospective observational study. Eur J Anaesthesiol. 2014 Jul;31(7):371-80. doi: 10.1097/EJA.0000000000000064.

    PubMed 24625464
  • Mesquida J, Saludes P, Gruartmoner G, Espinal C, Torrents E, Baigorri F, Artigas A. Central venous-to-arterial carbon dioxide difference combined with arterial-to-venous oxygen content difference is associated with lactate evolution in the hemodynamic resuscitation process in early septic shock. Crit Care. 2015 Mar 28;19(1):126. doi: 10.1186/s13054-015-0858-0.

    PubMed 25888382
  • Routsi C, Vincent JL, Bakker J, De Backer D, Lejeune P, d'Hollander A, Le Clerc JL, Kahn RJ. Relation between oxygen consumption and oxygen delivery in patients after cardiac surgery. Anesth Analg. 1993 Dec;77(6):1104-10. doi: 10.1213/00000539-199312000-00004.

    PubMed 8250298
  • Vallet B, Teboul JL, Cain S, Curtis S. Venoarterial CO(2) difference during regional ischemic or hypoxic hypoxia. J Appl Physiol (1985). 2000 Oct;89(4):1317-21. doi: 10.1152/jappl.2000.89.4.1317.

    PubMed 11007564
  • Bakker J, Vincent JL, Gris P, Leon M, Coffernils M, Kahn RJ. Veno-arterial carbon dioxide gradient in human septic shock. Chest. 1992 Feb;101(2):509-15. doi: 10.1378/chest.101.2.509.

    PubMed 1735281
  • Mecher CE, Rackow EC, Astiz ME, Weil MH. Venous hypercarbia associated with severe sepsis and systemic hypoperfusion. Crit Care Med. 1990 Jun;18(6):585-9. doi: 10.1097/00003246-199006000-00001.

    PubMed 2111753
  • Groeneveld AB. Interpreting the venous-arterial PCO2 difference. Crit Care Med. 1998 Jun;26(6):979-80. doi: 10.1097/00003246-199806000-00002. No abstract available.

    PubMed 9635634
  • Faden H. Prophylactic antibiotics in pediatrics cardiovascular surgery: current practices. Ann Thorac Surg. 1981 Mar;31(3):211-3. doi: 10.1016/s0003-4975(10)60928-9.

    PubMed 7212816
  • Moller JE, Sionis A, Aissaoui N, Ariza A, Belohlavek J, De Backer D, Farber G, Gollmann-Tepekoylu C, Mebazaa A, Price S, Swol J, Thiele H, Hassager C. Step by step daily management of short-term mechanical circulatory support for cardiogenic shock in adults in the intensive cardiac care unit: a clinical consensus statement of the Association for Acute CardioVascular Care of the European Society of Cardiology SC, the European Society of Intensive Care Medicine, the European branch of the Extracorporeal Life Support Organization, and the European Association for Cardio-Thoracic Surgery. Eur Heart J Acute Cardiovasc Care. 2023 Jul 7;12(7):475-485. doi: 10.1093/ehjacc/zuad064.

    PubMed 37315190
  • Chiolero RL, Revelly JP, Leverve X, Gersbach P, Cayeux MC, Berger MM, Tappy L. Effects of cardiogenic shock on lactate and glucose metabolism after heart surgery. Crit Care Med. 2000 Dec;28(12):3784-91. doi: 10.1097/00003246-200012000-00002.

    PubMed 11153615
  • Khosravani H, Shahpori R, Stelfox HT, Kirkpatrick AW, Laupland KB. Occurrence and adverse effect on outcome of hyperlactatemia in the critically ill. Crit Care. 2009;13(3):R90. doi: 10.1186/cc7918. Epub 2009 Jun 12.

    PubMed 19523194

Questions about this trial

What is this clinical trial studying?

An observational study of Cardiogenic Shock, run by University Hospital, Montpellier at 1 site in France.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 2 inclusion and 14 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: opening soon, as of the sponsor's last update on 20 Apr 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in France. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Aurore Ughetto, MD (+33467335958, a-ughetto@chu-montpellier.fr), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

optimal flow (time frame: Day 1 (ECMO initiation), Day 2 (24 hours after ECMO initiation), and Day 3 (48 hours after ECMO initiation).). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT06936839, which also lists 18 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 20 Apr 2025.

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