Echocardiographic Predictors of Successful Extracorporeal Membrane Oxygenation Weaning After Refractory Cardiogenic Shock

Ultrasound Assessment in Cardiogenic Shock Weaning: A Review of the State of the Art

“…Weaning can be attempted when the ejection fraction of the left ventricle is higher than 35% and/or the left-ventricular outflow tract velocity time integral (VTI) is higher than 15 cm/s, with a minimal ECMO flow under 1.5 L/min or less than 1500 rpm [ 9 ]. Previous studies have also proposed lower values of both ejection fraction (around 20–25%) and VTI (10 cm/s) for a successful weaning [ 32 , 33 ] ( Figure 3 and Figure 4 ).…”

“…Furthermore, dynamic changes in tissular doppler parameters have been shown to predict successful weaning from ECMO, with an improvement in lateral e′ velocity. These parameters have been proposed as a more accurate predictor of myocardial reserve [ 32 ]. Diastolic parameters and the estimation of filling pressures, such as mitral E velocity or its time of deceleration, do not discriminate between successfully weaned patients and failed ones [ 33 ].…”

Response to “Echocardiographic Predictors of Successful Extracorporeal Membrane Oxygenation Weaning after Refractory Cardiogenic Shock”

“…I read with great interest the recent article by Kim et al 1 Weaning from venoarterial (V-A) extracorporeal membrane oxygenation (ECMO) at the earliest possible time is an essential consideration in V-A ECMO, as there is a direct relationship between the duration of V-A ECMO and mortality. 2 Premature V-A ECMO weaning is fraught with complications as recannulation is difficult following decannulation.…”

Echocardiography in Weaning Right Ventricular Mechanical Circulatory Support: Are We Measuring the Right Stuff?

“…5,6 Echocardiographic parameters suggesting left ventricular (LV) recovery have been studied extensively, validated in further studies, and have been incorporated into weaning algorithms. [7][8][9] Typically, LV ejection fraction (EF)  25%, aortic velocity-time integral (VTI)  10 cm, and mitral annular systolic velocity  6 cm/s, with minimal MCS support, are predictive of a successful wean. 10 However, robust objective echocardiographic measures of RV recovery remain more elusive.…”

“…LAI RV = (VTI TR x RVED length ) / RVED area , where a LAI RV value  18 indicated normal RV adaptability. Kim et al, 41 studied 92 patients with refractory cardiogenic shock supported with peripheral VA-ECMO and compared echocardiographic parameters at baseline ECMO support to those at 30-50% flows. With respect to RV function, only S' > 10% increase from baseline proved to be an independent predictor of successful ECMO weaning.…”