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Introduction
There are several indications for venoarterial extracorporeal membrane oxygenation (VA-ECMO) [1-4] including shock with low cardiac output [4] or patients after cardiopulmonary resuscitation [3] . Venous drainage of the VA-ECMO is dependent on sufficient supply of blood drawn from the large veins, typically the vena cava [5] . Due to an endothelial cell damage, a sepsis like syndrome is frequent in diseases like cardiogenic shock and the post resuscitation syndrome [6,7] . As part of a sepsis like syndrome, capillary leakage can induce an intravascular hypovolemia. These facts might trigger a liberal intravenous fluid therapy to VA-ECMO patients. While a more liberal fluid therapy might be lifesaving in the initial phase of sepsis, several studies suggest adverse outcome associated with excessive fluid balance during the intensive care unit stay [8-10] . In a targeted temperature study of patients after out of hospital cardiac arrest, high intravenous fluid therapy early after return of spontaneous circulation was associated with more rearrests and increased pulmonary edema [11] . This might be less relevant for prognosis in case of extracorporeal therapy if organ perfusion and oxygenation can be insured by sufficient VA-ECMO blood flow. We therefore analyzed all VA-ECMO patients treated at our institution in order to evaluate fluid balance and volume therapy in respect of outcome focusing on the early time period after implantation.
Methods
We report retrospective data of a single center registry of patients on VA-ECMO. All patients presented at the Heart Center Freiburg University between October 2010 and November 2015. Data derived from the registry was blinded to patient identity and covered by an ethics approval (EK-Freiburg 151/14). For data analysis t-test, ANOVA, χ2 -test or Mantel-Cox were employed as applicable and a P <= .05 was considered statistically significant. All values are given as mean ± SEM if not otherwise stated.
Patient selection
Within October 2010 and November 2015, a total of 230 VA-ECMO implantations were performed at the Heart Center Freiburg University. Indication for VA-ECMO was driven by the clinical judgment of the responsible physicians being part of our ECMO response team. Typical indications for VA ECMO support were cardiogenic shock with mean arterial blood pressure below 60 mmHg despite high doses of at least two vasopressors or ongoing cardiopulmonary resuscitation...