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AIMS: Limited data exist on echocardiographic predictors of weaning from veno-arterial extracorporeal membrane oxygenation (V-A ECMO). We aimed to test the performance of different echocardiographic indices to predict weaning from V-A ECMO and free survival after weaning. METHODS AND RESULTS: Observational study including patients with cardiogenic shock submitted to V-AECMO. Echocardiography was performed after V-AECMO placement and daily during the weaning trial to assess cardiac recovery. Echocardiography data after V-A ECMO implantation and during the last weaning trial before V-A ECMO removal were analysed. Besides traditional parameters, total isovolumic time (t-IVT, a left ventricular performance index) and mitral annular plane systolic excursion (MAPSE) were also tested. Seventy-six patients were included. A greater ventricular velocity time integral (LVOT VTI) at baseline was associated with a five-fold increase in weaning success (P 6.15 mm (P = 0.001) did. TAPSE and S' at tricuspid annulus showed an analogous association. During the weaning trial t-IVT, LVEF, MAPSE, LVOT VTI, and TAPSE all improved significantly (P 12.3 cm (P 8.9 mm (P 16 mm (<0.001), and E/e' < 15.5 (P = 0.001) were associated with weaning success and free survival after weaning. LVEF did not predict the weaning success and survival at any time-point (P = 0.230). CONCLUSION: Longitudinal function, t-IVT and native ejection, measured with LVOT VTI, are reliable parameters to predict weaning success in V-A ECMO whereas the LVEF, although dynamically changing during weaning trial, it is not.
Tavazzi et al. (Wed,) studied this question.