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

Darae Kim; Woo Jin Jang; Taek Kyu Park; Yang Hyun Cho; Jin-Oh Choi; Eun-Seok Jeon; Jeong Hoon Yang

doi:10.1016/j.echo.2020.12.002

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

J Am Soc Echocardiogr. 2021 Apr;34(4):414-422.e4. doi: 10.1016/j.echo.2020.12.002. Epub 2020 Dec 13.

Authors

Darae Kim¹, Woo Jin Jang², Taek Kyu Park¹, Yang Hyun Cho³, Jin-Oh Choi¹, Eun-Seok Jeon¹, Jeong Hoon Yang⁴

Affiliations

¹ Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
² Division of Cardiology, Department of Medicine, Ewha Womans University Hospital, Seoul, Korea.
³ Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
⁴ Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. Electronic address: jhysmc@gmail.com.

PMID: 33321165
DOI: 10.1016/j.echo.2020.12.002

Abstract

Background: Limited data are available regarding echocardiographic predictors for successful weaning from venoarterial (VA) extracorporeal membrane oxygenation (ECMO). We sought to determine whether echocardiographic parameters during ECMO flow study could predict successful weaning from ECMO.

Methods: A total of 92 ECMO patients from a multicenter ECMO registry underwent VA-ECMO flow study with transthoracic echocardiography before a weaning trial. During VA-ECMO flow study, flow was decreased by 30%-50% of the initial flow for 15 minutes, and echocardiography was performed both at baseline and after flow reduction. Changes of echocardiographic parameters were compared between the successful and failed weaning group.

Results: Sixty-four of the 92 patients were able to be weaned from VA-ECMO successfully. During VA-ECMO flow study, both lateral e' and tricuspid annular S' velocity improved significantly in the successful weaning group, while such findings were not observed in the failed weaning group. From univariable analysis, left heart decompression, improvement of lateral e' velocity, and improvement of tricuspid annular S' velocity showed significant association with successful VA-ECMO weaning. Predictability of the model with the change of lateral e' and tricuspid annular S' according to the reduction of ECMO flow for successful weaning from VA-ECMO is much higher than that of the model with conventional echocardiographic predictors from previous studies (left ventricular ejection fraction > 20%-25%, left ventricular time-velocity integral ≥ 10 cm, mitral annulus S' ≥ 6 cm/sec).

Conclusions: Improvement of lateral e' velocity and tricuspid annular S' velocity during VA-ECMO flow study may better represent cardiac reserve from a recovering heart than conventional echocardiographic parameters at minimal flow. Assessment of tissue Doppler parameters during ECMO flow study is a simple and feasible method to guide physicians on the optimal time to wean from ECMO.

Keywords: Echocardiography; Extracorporeal membrane oxygenation; Weaning.

Publication types

Multicenter Study

MeSH terms

Echocardiography
Extracorporeal Membrane Oxygenation*
Humans
Shock, Cardiogenic / diagnostic imaging
Shock, Cardiogenic / therapy
Stroke Volume
Ventricular Function, Left