Prognostic value of post VA ECMO weaning fever

Background Fever is a common finding after withdrawal of circulatory support in patients recovering from cardiogenic shock. However, its prognostic implications and potential association with early infection following venoarterial extracorporeal membrane oxygenation (VA-ECMO) removal remain unclear. Purpose To evaluate the prognostic significance of fever after VA-ECMO weaning and its relationship with the early development of infection. Methods We conducted a retrospective observational study based on a prospective registry of patients who underwent emergent peripheral VA-ECMO implantation between 2020 and 2025. Only patients surviving ≥48 hours after ECMO removal were included. Fever was defined as a body temperature ≥37.5°C. Laboratory parameters and infection onset were assessed within five days post-decannulation. Results Among 38 patients analysed, 17 (44.7%) developed fever within 48 hours of ECMO withdrawal. Compared with the afebrile group, febrile patients required similar vasoactive support (29.4% vs. 24%, p=0.697) and showed comparable infection rates (23.5% vs. 23.8%, p=0.984). No significant differences were observed in mortality or neurological outcomes at discharge. Regarding inflammatory markers, all patients exhibited transient increases in white blood cell count and C-reactive protein (CRP). Those with infection displayed a sustained CRP elevation and a procalcitonin (PCT) rebound from day 3 post-decannulation. Conclusions Fever is frequent after peripheral VA-ECMO weaning but is not associated with infection or worse short-term outcomes. The observed pattern of inflammatory markers suggests a systemic inflammatory response related to ECMO withdrawal rather than infection itself. Further studies are warranted to elucidate its prognostic impact in cardiogenic shock recovery.