Acute cardiac care & resuscitation
Venoarterial Extracorporeal Membrane Oxygenation (VA-ECMO) Weaning Strategy Using Adjusted Pulse Pressure by Vasoactive Inotropic Score in AMI Complicated by Cardiogenic Shock
Authors' conclusion
PP adjusted by VIS taken 12 h following VA-ECMO initiation can predict weaning from VA-ECMO more successfully than PP alone, and its low value was associated with a higher risk of mortality in AMI-CS patients.
Study context
- Population
- Patients with AMI complicated by cardiogenic shock receiving VA-ECMO, January 2010 to August 2021
- Participants
- 213 patients
- Exposure
- Successful vs failed VA-ECMO weaning; 12 h pulse pressure (PP)/√vasoactive inotropic score (VIS) vs 12 h PP alone
- Successful weaningn = 151
- Outcome
- Successful VA-ECMO weaning
Methodological detailssingle-centre registry, Serial PP and VIS measured immediately, 12, 24 and 48 h after VA-ECMO insertion; PP adjusted by VIS = PP/√VIS
- Single-centre registry
- Serial PP and VIS measured immediately, 12, 24 and 48 h after VA-ECMO insertion; PP adjusted by VIS = PP/√VIS
Main finding
As reported in the abstract
Successful VA-ECMO weaning and its prediction by PP and PP/√VIS
| Group | Value | PP immediately after insertion, median (range as printed) | PP/√VIS immediately after insertion | 12 h PP | 12 h PP/√VIS | PP immediately after insertion |
|---|---|---|---|---|---|---|
| Successful weaning | 70.9% | 26.0 (15.5-46.0) | 11.1 (5.1-25.0) | 24.0 (4.0-38.0) | 10.1 (5.7-22.0) | |
| Failed weaning | 6.0 (3.1-14.2) | 12.5 (6.0-25.5) | 2.9 (1.7-5.9) | 21.0 (12.5-33.0) |
Value
Successful weaning70.9%
Failed weaning— not stated in the abstract
PP immediately after insertion, median (range as printed)
Successful weaning26.0 (15.5-46.0)
Failed weaning— not stated in the abstract
PP/√VIS immediately after insertion
Successful weaning11.1 (5.1-25.0)
Failed weaning6.0 (3.1-14.2)
12 h PP
Successful weaning24.0 (4.0-38.0)
Failed weaning12.5 (6.0-25.5)
12 h PP/√VIS
Successful weaning10.1 (5.7-22.0)
Failed weaning2.9 (1.7-5.9)
PP immediately after insertion
Successful weaning— not stated in the abstract
Failed weaning21.0 (12.5-33.0)
- Successful weaning vs Failed weaning: P = 0.386 — PP immediately after insertion
- Successful weaning vs Failed weaning: P = 0.118 — PP/√VIS immediately after insertion
- Successful weaning vs Failed weaning: P = 0.007 — 12 h PP
- Successful weaning vs Failed weaning: P < 0.001 — 12 h PP/√VIS
- 12 h PP/√VIS AUC for successful weaning
- 0.80 (95% CI 0.72-0.88, P < 0.001)
- 12 h PP alone AUC for successful weaning
- 0.67 (95% CI 0.57-0.77, P = 0.002)
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| Mortality by 12 h PP/√VIS (low ≤7 vs high >7)Low 12 h PP/√VIS (≤7)vs High 12 h PP/√VIS (>7)6-month follow-up mortality · per-group values are in-hospital mortality | 2.41 (1.49–3.90) | P < 0.001 | |
| 0.20.5125Hazard ratio (log scale) |
| Outcome | Successful weaning | Failed weaning | P value |
|---|---|---|---|
| PP and PP/√VIS immediately after VA-ECMO insertion | |||
| PP | 26.0 (15.5-46.0) | 21.0 (12.5-33.0) | |
| PP/√VIS | 11.1 (5.1-25.0) | 6.0 (3.1-14.2) | |
| PP and PP/√VIS at 12 h · 12 h after insertion | |||
| PP | 24.0 (4.0-38.0) | 12.5 (6.0-25.5) | |
| PP/√VIS | 10.1 (5.7-22.0) | 2.9 (1.7-5.9) | |
| Mortality by 12 h PP/√VIS (low ≤7 vs high >7)Low 12 h PP/√VIS (≤7) vs High 12 h PP/√VIS (>7) · in-hospital mortality · per-group values are in-hospital mortality | P < 0.001 |
- PP and PP/√VIS immediately after VA-ECMO insertion — No difference in PP
- P = 0.386
- PP and PP/√VIS immediately after VA-ECMO insertion — No difference in PP/√VIS
- P = 0.118
- PP and PP/√VIS at 12 h — PP higher with successful weaning
- P = 0.007
- PP and PP/√VIS at 12 h — PP/√VIS higher with successful weaning
- P < 0.001
- Mortality by 12 h PP/√VIS (low ≤7 vs high >7): Low 12 h PP/√VIS (≤7) 44.4%
- Mortality by 12 h PP/√VIS (low ≤7 vs high >7): High 12 h PP/√VIS (>7) 19.8%
PP and PP/√VIS at 12 h · 12 h after insertion
- Serial PP and PP/√VIS at 12, 24 and 48 h significantly higher with successful weaning
Original publication
VA-ECMO Weaning Strategy Using Adjusted Pulse Pressure by Vasoactive Inotropic Score in AMI Complicated by Cardiogenic Shock. ESC Heart Fail. Published 9 May 2024. doi:10.
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