Incidence and predictors of weaning failure from veno‐arterial extracorporeal membrane oxygenation therapy in patients with cardiogenic shock

Abstract Aims This study aimed to investigate incidence and predictors of weaning failure and in‐hospital death after successful weaning from veno‐arterial extracorporeal membrane oxygenation (VA‐ECMO) in patients with cardiogenic shock (CS). Methods and results Overall, 685 patients with CS treated with VA‐ECMO from 23 tertiary care centres in 7 countries were analysed (median age 57 [interquartile range 49–66] years, 542 [79.1%] male, median lactate 7.6 [interquartile range 4.1–12.7] mmol/L). The cause of CS was acute myocardial infarction in 438 (63.9%) patients, and 431 (62.9%) patients presented with cardiac arrest. A total of 410 patients (59.9%) were successfully weaned from VA‐ECMO, whereas in 275 patients (40.1%) weaning failed (i.e. patients died on or within 48 h after VA‐ECMO support). Of the successfully weaned patients, 150 (36.6%) died before hospital discharge. On multivariable logistic regression, predictors for both patient groups varied: age (per 10 years, odds ratio [OR] 1.49, 95% confidence interval [CI] 1.25–1.76; p  < 0.001) and cardiac arrest before VA‐ECMO implantation (OR 1.64, 95% CI 1.01–2.64; p  = 0.04) were associated with weaning failure, whereas lactate clearance within 24 h after VA‐ECMO initiation was associated with successful weaning (OR 0.21, 95% CI 0.1–0.44; p  < 0.001). In‐hospital death after successful weaning was more likely with higher age (per 10 years, OR 1.56, 95% CI 1.24–1.97; p  < 0.001), renal replacement therapy (OR 2.56, 95% CI 1.4–4.68; p  = 0.002) and bleeding events (OR 2.93, 95% CI 1.4–6.14; p  = 0.004). Conclusion Weaning from VA‐ECMO fails in 40% of patients treated with VA‐ECMO for CS. When successful, survival after VA‐ECMO weaning mostly depends on age and the incidence of device‐ and shock‐related complications.