Pragmatic Assessment of VA-ECMO Decannulation Readiness After Extracorporeal Cardiopulmonary Resuscitation for Out-of-Hospital Cardiac Arrest

doi:10.1016/j.jacadv.2026.103049

Pragmatic Assessment of Venoarterial-extracorporeal Membrane Oxygenation (VA-ECMO) Decannulation Readiness After Extracorporeal Cardiopulmonary Resuscitation for Out-of-Hospital Cardiac Arrest

JACC AdvPublished 29 Jul 2026Consecutive out-of-hospital cardiac arrest (OHCA) patients treated under the Minnesota Resuscitation Consortium extracorporeal cardiopulmonary resuscitation (ECPR) protocol from December 2015 to March 2023 were analyzed

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Authors' conclusion

Our study identifies several pragmatic variables, noninvasive and accessible at the bedside that are predictive of successful decannulation among OHCA patients undergoing ECPR. Prospective validation of a composite decannulation prediction score incorporating these variables is warranted to aid decision-making.

Study context

Population: OHCA patients treated with ECPR under the Minnesota Resuscitation Consortium ECPR protocol, December 2015 to March 2023OHCA ECPR patients, 125 underwent VA-ECMO decannulation
Participants: 390 patients

Comparison: Hemodynamic, vasoactive medication, echocardiographic, and mechanical circulatory support variables were compared between successful and failed decannulation
successful decannulationn = 110

Methodological detailsBayesian additive regression trees, multivariable logistic regression

Bayesian additive regression trees
Multivariable logistic regression

Main finding

As reported in the abstract

Successful VA-ECMO decannulation

Successful, of the 125 who underwent VA-ECMO decannulation

110

88%

Further findings

Witnessed arrest

successful decannulation100%

failed decannulation73%

Bystander CPR

successful decannulation68.6%

failed decannulation36.4%

Variables associated with decannulation success on weaning readiness assessment

Comparison	← Lower ←→ Higher →	OR (95% CI)	P value
Left ventricular ejection fraction at lowest VA-ECMO flow · associated with decannulation success	0.512	0.96 (0.92–0.99)	P = 0.024
Arterial pulsatility · associated with decannulation success	0.512	0.95 (0.90–0.99)	P = 0.027
Vasoactive inotrope score · associated with decannulation success	0.512	1.16 (1.04–1.32)	P = 0.013
Days on VA-ECMO support · associated with decannulation success	0.512	1.40 (1.13–1.79)	P = 0.003
	0.512Odds ratio (log scale)

Witnessed arrest: P = 0.04
Bystander CPR: P = 0.05

Prediction of decannulation success by Bayesian additive regression trees model (left ventricular ejection fraction, pulsatility, vasoactive-inotrope score, predecannulation VA-ECMO flow, concomitant intra-aortic balloon pump support)

Area under the curve: 0.91

Original publication

Pragmatic Assessment of VA-ECMO Decannulation Readiness After Extracorporeal Cardiopulmonary Resuscitation for Out-of-Hospital Cardiac Arrest. JACC Adv. Published 29 July 2026. doi:10.1016/j.jacadv.2026.103049

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Summarised from the published abstract; every number is checked against it