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Acute cardiac care & resuscitationResearch article

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

JACC AdvPublished

  • Consecutive OHCA patients treated under the Minnesota Resuscitation Consortium extracorporeal cardiopulmonary resuscitation (ECPR) protocol from December 2015 to March 2023 were analyzed
  • Bayesian additive regression trees
  • multivariable logistic regression
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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

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

Bystander CPR

Variables associated with decannulation success on weaning readiness assessment

ComparisonOR (95% CI)P value
left ventricular ejection fraction at lowest VA-ECMO flow · associated with decannulation success0.96 (0.92–0.99)P = 0.024
arterial pulsatility · associated with decannulation success0.95 (0.90–0.99)P = 0.027
Vasoactive inotrope score · associated with decannulation success1.16 (1.04–1.32)P = 0.013
days on VA-ECMO support · associated with decannulation success1.40 (1.13–1.79)P = 0.003
  • 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