Predicting Parameters for Successful Weaning from Veno-Arterial Extracorporeal Membrane Oxygenation in Cardiogenic Shock

Kenichiro Sawada, Shoji Kawakami, Shunsuke Murata, Kunihiro Nishimura, Yoshio Tahara, Hayato Hosoda, Takahiro Nakashima, Yu Kataoka, Yasuhide Asaumi, Teruo Noguchi, Masaru Sugimachi, Tomoyuki Fujita, Junjiro Kobayashi, Satoshi Yasuda

Research output: Contribution to journalArticlepeer-review

Abstract

Aims: Percutaneous veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is utilized for patients with cardiogenic shock or cardiac arrest. However, the procedure protocol for weaning from VA-ECMO has not been well established. The present study aimed to determine the usefulness of echocardiographic and pulmonary artery catheter parameters for predicting successful weaning from VA-ECMO in patients with refractory cardiogenic shock. Methods and results: We retrospectively studied 50 patients who were hospitalized and supported by VA-ECMO for >48 h between January 2013 and March 2017. Patients successfully weaned from VA-ECMO without reintroduction of VA-ECMO or left ventricular assist device implantation were defined as 30 day survivors. Echocardiographic and pulmonary artery catheter parameters were evaluated when ECMO flow was limited to a maximum of 1.5–2.0 L/min. Twenty-four patients were successfully weaned from VA-ECMO, whereas 26 were not. Fractional shortening, corrected left ventricular ejection time (LVETc, defined as LVET divided by the square root of heart rate), left ventricular outflow tract velocity time integral, and LVETc divided by pulmonary artery wedge pressure (PAWP) were significantly larger in the 30 day survivor groups. Multivariable analysis revealed LVETc∕PAWP as a significant independent predictor of successful weaning (LVETc∕PAWP, odds ratio 0.82, 95% confidence interval 0.71–0.94, P = 0.005). Receiver operating characteristic curve analysis revealed 15.9 as the optimal LVETc∕PAWP for predicting successful weaning (area under the curve 0.82). Conclusions: The present findings indicate that LVETc∕PAWP is a potential predictor of successful weaning from VA-ECMO.

Original languageEnglish
Pages (from-to)471-480
Number of pages10
JournalESC Heart Failure
Volume8
Issue number1
DOIs
Publication statusPublished - 2021 Feb
Externally publishedYes

Keywords

  • Echocardiography
  • Mechanical circulatory support
  • Pulmonary artery catheter
  • Refractory cardiogenic shock
  • Veno-arterial extracorporeal membrane oxygenation weaning

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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