ID:44 FC-D11-1 Validation of the JCS Guideline Criteria for Successful V-A ECMO Decannulation and Added Value of an Additional Hemodynamic Indicator

Background: Weaning from Veno-Arterial Extracorporeal Membrane Oxygenation (V-A ECMO) remains challenging in patients with cardiogenic shock. Although the 2023 Japanese Circulation Society (JCS) guidelines provide criteria for ECMO weaning, supporting evidence is limited. This study aimed to validate the JCS criteria and identify additional hemodynamic indicators to improve successful decannulation prediction. Methods: A retrospective multi-center study was conducted of adult patients treated with V-A ECMO between April 2020 and June 2025. Based on the JCS guidelines, patients achieving both mean arterial pressure ≥ 60 mmHg and mixed venous oxygen saturation (SvO2) ≥ 60% after reducing ECMO flow to 1.0-1.5 L/min were assigned to Criteria-Met Group; others formed the Criteria-Unmet Group. Successful ECMO weaning was defined as survival for more than 48 hours after decannulation without re-cannulation. Additional hemodynamic parameters were analyzed to assess their incremental value in predicting this clinical success. Results: A total of 57 patients were analyzed (mean age 61 years; 75% male). The underlying cardiac diseases were acute myocardial infarction (n=35), arrhythmia (n=11), fulminant myocarditis (n=8), and non-ischemic cardiomyopathy (n=3). In the Criteria-Met Group (n=49), the successful weaning rate was 96%. In Criteria-Unmet Group (n=8), 6 (75%) were successfully weaned. The JCS criteria demonstrated a sensitivity of 0.89, specificity of 0.50, positive predictive value (PPV) of 0.96, and positive likelihood ratio (PLR) of 1.78. Incorporation of right atrial pressure (RAP) ≤ 10 mmHg into the JCS criteria improved performance, yielding a sensitivity 0.81, specificity 0.75, PPV 0.98, and PLR 3.24. Conclusion: The JCS guideline criteria are effective for predicting successful ECMO weaning but have limited specificity for identifying weaning failure. Incorporation of RAP ≤ 10 mmHg significantly enhances diagnostic specificity and may serve as a valuable indicator for optimizing the timing of safe decannulation.