ID:32 OA1-8 Early Achievement of Low Vasoactive-Inotropic Score as a Therapeutic Target in VA-ECMO: A Multicenter Propensity Score-Matched Analysis

Background: Despite advances in veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support for cardiogenic shock, the impact of early pharmacologic management on outcomes remains poorly defined. We investigated whether actively achieving a low vasoactive-inotropic score (VIS < 10) within 24 hours serves as a beneficial therapeutic target associated with enhanced metabolic recovery and survival. Methods: This multicenter retrospective study analyzed adult CS patients receiving VA-ECMO from the Chinese Society of Extracorporeal Life Support (CSECLS) registry (August 2015 - July 2025). Patients were stratified according to achievement of a low VIS target (<10) within the first 24 hours. The primary outcome was in-hospital mortality; secondary outcomes included 24-hour lactate clearance, ECMO weaning success, and major complications. Propensity score matching (1:1) and multivariable logistic regression were used to adjust for confounders. Results: Among 3474 included patients, 1642 (47.2%) successfully achieved the low-VIS target (<10) at 24 hours. In the propensity-matched cohort, the “Target Achievement” (low-VIS) group demonstrated superior 24-hour lactate clearance (55.0% vs. 42.6%, p < 0.001) and reduced in-hospital mortality (38.8% vs. 45.0%, p = 0.003) compared to the “Non-Achievement” group. Additionally, achieving the target was associated with a significantly lower burden of renal, respiratory, metabolic, and cardiovascular complications. Multivariable analysis confirmed that failure to achieve the target (VIS(24h) ≥10) was an independent predictor of mortality (aOR 1.24, 95% CI 1.06–1.44; p = 0.007) and impaired metabolic recovery. Conclusions: Early achievement of a low VIS (<10) at 24 hours is independently associated with enhanced metabolic recovery, reduced complications, and improved in-hospital survival. These findings support “early vasoactive de-escalation” as a viable therapeutic target to optimize post-ECMO management.