Acute cardiac care & resuscitation
Norepinephrine Equivalent Dose for Mortality Risk Stratification in Venoarterial Extracorporeal Membrane Oxygenation (VA-ECMO) Cardiogenic Shock
Authors' conclusion
In VA-ECMO-supported CS with vasoplegia, vasopressor burden shows a linear relationship with mortality. A NEE threshold of 0.443 μg·kg-1·min-1 may identify patients with elevated mortality risk.
Study context
- Population
- Patients with cardiogenic shock (CS) requiring VA-ECMOconsecutive patients with CS requiring VA-ECMO
- Participants
- 572 patients
- Exposure
- High vs lower vasopressor burden by NEE threshold of 0.443 μg·kg-1·min-1
- Outcome
- NEE at ECMO initiation
- Follow-up
- ECMO initiation
Methodological detailsconsecutive patients
- Consecutive patients
Main finding
As reported in the abstract
Median NEE
0.30 (IQR: 0.09-0.72) μg·kg-1·min-1
Received norepinephrine
86.2%
Observational data: associations, not effects.
Further findings
| Outcome | Lower vasopressor burden | Estimate | P value | |
|---|---|---|---|---|
| Mortality, per NEE incrementLinear dose-response | HR 1.06 (95% CI 1.04–1.08) | P < 0.001 | ||
| 30-day mortality · 30 daysHigh vasopressor burden (NEE ≥0.443 μg·kg-1·min-1)vs Lower vasopressor burdenUnadjusted mortality comparison P < 0.001 | 42.6% | adjusted HR 1.42 (95% CI 1.11–1.81) | P = 0.005 | |
| Factors associated with high vasopressor burdenBaseline lactate · multivariable logistic regression | OR 1.05 per mmol/L (95% CI 1.01–1.09) | |||
| Factors associated with high vasopressor burdenSurvival After Veno-Arterial ECMO score · lower score associated with high burden · multivariable logistic regression | OR 0.96 per point (95% CI 0.92–1.00) | |||
| 0.512Ratio (log scale) |
Factors associated with high vasopressor burden
| OR (95% CI) | ||
|---|---|---|
| Mechanical ventilationMultivariable logistic regression | 2.96 (1.08–8.07) | |
| Prior epinephrine useMultivariable logistic regression | 1.87 (1.12–3.14) | |
| Renal replacement therapy before VA-ECMOMultivariable logistic regression | 1.76 (1.02–3.03) | |
| Left ventricular unloadingInversely associated · multivariable logistic regression | 0.54 (0.34–0.87) | |
| 0.10.31310Odds ratio (log scale) |
- 30-day mortality: High vasopressor burden (NEE ≥0.443 μg·kg-1·min-1) 61.8%
Original publication
Norepinephrine Equivalent Dose for Mortality Risk Stratification in VA-ECMO Cardiogenic Shock. JACC Adv. Published October 2026. doi:10.
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