Incidence and predictors of weaning failure from veno-arterial extracorporeal membrane oxygenation therapy in patients with cardiogenic shock

Angela Dettling, Caroline Kellner, Jonas Sundermeyer, Benedikt N. Beer, Lisa Besch, Letizia Fausta Bertoldi, Stefan Blankenberg, Jeroen Dauw, Dennis Eckner (Co-author), Ingo Eitel, Tobias Graf, Patrick Horn, Joanna Jozwiak-Nozdrzykowska, Paulus Kirchhof, Stefan Kluge, Jannis Krais, Dirk von Lewinski, Axel Linke, Peter Luedike, Enzo LuesebrinkPeter Nordbeck, Federico Pappalardo, Matthias Pauschinger (Co-author), Alastair Proudfoot, Tienush Rassaf, Hermann Reichenspurner, Can Martin Sag, Clemens Scherer, P. Christian Schulze, Robert H. G. Schwinger, Carsten Skurk, Marek Sramko, Guido Tavazzi, Holger Thiele, Nuccia Morici, Ephraim B. Winzer, Dirk Westermann, Benedikt Schrage, Norman Mangner

Research output: Contribution to journalOriginal Articlepeer-review

Abstract

Aims This study aimed to investigate incidence and predictors of weaning failure and in-hospital death after successful weaning from veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in patients with cardiogenic shock (CS). Methods and results Overall, 685 patients with CS treated with VA-ECMO from 23 tertiary care centres in 7 countries were analysed (median age 57 [interquartile range 49-66] years, 542 [79.1%] male, median lactate 7.6 [interquartile range 4.1-12.7] mmol/L). The cause of CS was acute myocardial infarction in 438 (63.9%) patients, and 431 (62.9%) patients presented with cardiac arrest. A total of 410 patients (59.9%) were successfully weaned from VA-ECMO, whereas in 275 patients (40.1%) weaning failed (i.e. patients died on or within 48 h after VA-ECMO support). Of the successfully weaned patients, 150 (36.6%) died before hospital discharge. On multivariable logistic regression, predictors for both patient groups varied: age (per 10 years, odds ratio [OR] 1.49, 95% confidence interval [CI] 1.25-1.76; p < 0.001) and cardiac arrest before VA-ECMO implantation (OR 1.64, 95% CI 1.01-2.64; p = 0.04) were associated with weaning failure, whereas lactate clearance within 24 h after VA-ECMO initiation was associated with successful weaning (OR 0.21, 95% CI 0.1-0.44; p < 0.001). In-hospital death after successful weaning was more likely with higher age (per 10 years, OR 1.56, 95% CI 1.24-1.97; p < 0.001), renal replacement therapy (OR 2.56, 95% CI 1.4-4.68; p = 0.002) and bleeding events (OR 2.93, 95% CI 1.4-6.14; p = 0.004). Conclusion Weaning from VA-ECMO fails in 40% of patients treated with VA-ECMO for CS. When successful, survival after VA-ECMO weaning mostly depends on age and the incidence of device- and shock-related complications.
Original languageEnglish
Number of pages10
JournalEUROPEAN JOURNAL OF HEART FAILURE
Early online dateJan 2025
DOIs
Publication statusPublished - 17 Jan 2025

Keywords

  • Cardiogenic shock
  • Mechanical circulatory support
  • Mortality
  • Predictors
  • Veno-arterial extracorporeal membrane oxygenation
  • Weaning

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