Journal Article Ahead of print
PubMed: 42526189 DOI: 10.1016/j.jacadv.2026.103049
Pragmatic Assessment of VA-ECMO Decannulation Readiness After Extracorporeal Cardiopulmonary Resuscitation for Out-of-Hospital Cardiac Arrest.
JACC Adv 5(8):103049
Authors: Garima Dahiya, Laith Alhuneafat, Jason Bartos, Steffen Ventz, Daniel Gonzalez, Meagan Nowariak, Guido Tavazzi, Ziou Jiang, Gregory Mello, Jalal Agakishi, Natalie Hunninghake, Alejandra Gutierrez Bernal, Demetris Yannopoulos, Andrea Elliott
Affiliations
- Division of Critical Care Cardiology, Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA; Division of Cardiovascular Disease, University of Minnesota, Minneapolis, Minnesota, USA.
- Division of Cardiovascular Disease, University of Minnesota, Minneapolis, Minnesota, USA.
- Division of Biostatistics and Health Data Science, University of Minnesota, Minneapolis, Minnesota, USA.
- Division of Cardiovascular Disease, University of Minnesota, Minneapolis, Minnesota, USA; Advocate Heart Institute, Advocate Christ Medical Center, Oak Lawn, Illinois, USA.
- University of Minnesota Medical School, Minneapolis, Minnesota, USA.
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.
- Biostatistical Design and Analysis Center, University of Minnesota Clinical and Translational Science Institute, Minneapolis, Minnesota, USA.
- Advocate Heart Institute, Advocate Christ Medical Center, Oak Lawn, Illinois, USA.
Abstract
BACKGROUND
Readiness for venoarterial-extracorporeal membrane oxygenation (VA-ECMO) decannulation after extracorporeal cardiopulmonary resuscitation (ECPR) for out-of-hospital cardiac arrest (OHCA) remains poorly defined.
OBJECTIVES
The objective of the study was to identify bedside clinical variables associated with successful decannulation in OHCA patients treated with ECPR.
METHODS
Consecutive OHCA patients treated under the Minnesota Resuscitation Consortium ECPR protocol from December 2015 to March 2023 were analyzed. Hemodynamic, vasoactive medication, echocardiographic, and mechanical circulatory support variables were compared between successful and failed decannulation. Feature importance analysis was conducted using Bayesian additive regression trees and multivariable logistic regression.
RESULTS
Among 390 OHCA ECPR patients, 125 underwent VA-ECMO decannulation; 110 (88%) were successful. Failed decannulations were less likely to have been witnessed arrests (73% vs 100%; P = 0.04) and had lower rates of bystander CPR (36.4% vs 68.6%; P = 0.05). On weaning readiness assessment, left ventricular ejection fraction at lowest VA-ECMO flow (OR: 0.96; 95% CI: 0.92-0.99; P = 0.024), arterial pulsatility (OR: 0.95; 95% CI: 0.90-0.99; P = 0.027), Vasoactive inotrope score (OR: 1.16; 95%-CI: 1.04-1.32; P = 0.013) and days on VA-ECMO support (OR: 1.40; 95%-CI: 1.13-1.79; P = 0.003) were significantly associated with decannulation success. A Bayesian additive regression trees model incorporating left ventricular ejection fraction, pulsatility, vasoactive-inotrope score, predecannulation VA-ECMO flow, and concomitant intra-aortic balloon pump support predicted success with an area under the curve of 0.91.
CONCLUSIONS
Our study identifies several pragmatic variables, noninvasive and accessible at the bedside that are predictive of successful decannulation among OHCA patients undergoing ECPR. Prospective validation of a composite decannulation prediction score incorporating these variables is warranted to aid decision-making.
MeSH
Resuscitation, Cardiopulmonary Resuscitation, Extracorporeal Membrane Oxygenation, Out-Of-Hospital Cardiac Arrest, Heart Arrest