Abstract：
OBJECTIVE: Knowing the upper time limit for successful weaning from temporary mechanical circulatory support in cardiogenic shock will help with decision-making regarding advanced heart failure (HF) therapy or considering withdrawal of care. The aim of this study was to investigate the association between the support duration and successful weaning from veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in patients with cardiogenic shock.
RESULTS: A retrospective single-centre cohort study was conducted between January 2013 and June 2023. It included 100 consecutive patients with cardiogenic shock who were treated with VA-ECMO. Patients with out-of-hospital cardiac arrest were excluded. The primary outcome was successful weaning from VA-ECMO (i.e., VA-ECMO decannulation and survival to discharge). The association between the length of support duration and the weaning success rate was analysed. Patients were divided into three groups according to ECMO support duration: Group A (≤7 days), Group B (8-14 days), and Group C (≥15 days). Multivariable logistic regression analysis was used to evaluate the impact of the length of support duration on successful weaning of VA-ECMO. The median age was 67 years, and 73% of study participants were male. The underlying aetiologies of cardiogenic shock were as follows: acute myocardial infarction, 50; fulminant myocarditis, 19; cardiomyopathy, 15; valvular heart disease, 8; and other, 8. Seventy-five patients (75%) were attempted to wean VA-ECMO, and 67 moved on to decannulation. In total, 43 (43%) patients were successfully weaned from VA-ECMO. The median length of ECMO support duration was 8 [3-15] days. Compared with those who underwent successful ECMO decannulation, those who did not had a significantly longer support duration of VA-ECMO (5 [3-9] days vs. 12 [3-22] days, P = 0.004). The weaning success rate was significantly higher in patients with short support duration; 58% (29/50), 40% (10/25), 16% (4/25) in Groups A, B, and C, respectively (P = 0.002). Overall, none of the patients supported for over 24 days (0/11) were successfully weaned from VA-ECMO. On multivariable logistic regression analysis, the length of support duration was independently associated with successful weaning after adjusting for age, sex, underlying aetiology, and left ventricular ejection fraction (odds ratio, 0.813 [per 3 days]; 95% confidence interval, 0.679-0.914; P = 0.025).
CONCLUSIONS: Long support duration of VA-ECMO was significantly associated with a low rate of successful weaning in patients with cardiogenic shock. Patients who require VA-ECMO for over 1 week should start considering advanced HF therapy or withdrawal of care.
RESULTS: A retrospective single-centre cohort study was conducted between January 2013 and June 2023. It included 100 consecutive patients with cardiogenic shock who were treated with VA-ECMO. Patients with out-of-hospital cardiac arrest were excluded. The primary outcome was successful weaning from VA-ECMO (i.e., VA-ECMO decannulation and survival to discharge). The association between the length of support duration and the weaning success rate was analysed. Patients were divided into three groups according to ECMO support duration: Group A (≤7 days), Group B (8-14 days), and Group C (≥15 days). Multivariable logistic regression analysis was used to evaluate the impact of the length of support duration on successful weaning of VA-ECMO. The median age was 67 years, and 73% of study participants were male. The underlying aetiologies of cardiogenic shock were as follows: acute myocardial infarction, 50; fulminant myocarditis, 19; cardiomyopathy, 15; valvular heart disease, 8; and other, 8. Seventy-five patients (75%) were attempted to wean VA-ECMO, and 67 moved on to decannulation. In total, 43 (43%) patients were successfully weaned from VA-ECMO. The median length of ECMO support duration was 8 [3-15] days. Compared with those who underwent successful ECMO decannulation, those who did not had a significantly longer support duration of VA-ECMO (5 [3-9] days vs. 12 [3-22] days, P = 0.004). The weaning success rate was significantly higher in patients with short support duration; 58% (29/50), 40% (10/25), 16% (4/25) in Groups A, B, and C, respectively (P = 0.002). Overall, none of the patients supported for over 24 days (0/11) were successfully weaned from VA-ECMO. On multivariable logistic regression analysis, the length of support duration was independently associated with successful weaning after adjusting for age, sex, underlying aetiology, and left ventricular ejection fraction (odds ratio, 0.813 [per 3 days]; 95% confidence interval, 0.679-0.914; P = 0.025).
CONCLUSIONS: Long support duration of VA-ECMO was significantly associated with a low rate of successful weaning in patients with cardiogenic shock. Patients who require VA-ECMO for over 1 week should start considering advanced HF therapy or withdrawal of care.
摘要：
目的：了解心源性休克患者从临时机械循环支持中成功断奶的时间上限，将有助于做出关于晚期心力衰竭（HF）治疗或考虑退出治疗的决策。这项研究的目的是研究心源性休克患者的支持持续时间与静脉动脉体外膜氧合（VA-ECMO）成功撤机之间的关系。
结果：2013年1月至2023年6月进行了回顾性单中心队列研究。它包括100例接受VA-ECMO治疗的心源性休克患者。院外心脏骤停的患者被排除在外。主要结局是从VA-ECMO成功断奶(即，VA-ECMO拔管和存活出院)。分析了支持持续时间与断奶成功率之间的关系。根据ECMO支持时间将患者分为三组：A组（≤7天），B组（8-14天），和C组（≥15天）。采用多变量logistic回归分析评价支持持续时间对VA-ECMO成功断奶的影响。中位年龄为67岁,73%的研究参与者是男性。心源性休克的病因如下：急性心肌梗死，50;暴发性心肌炎，19；心肌病，15；心脏瓣膜病，8、其他8.75名患者(75%)试图戒断VA-ECMO，67开始拔管。总的来说,43例（43%）患者成功脱离VA-ECMO。ECMO支持持续时间的中位数为8[3-15]天。与那些成功进行ECMO拔管的人相比，那些没有明显更长的VA-ECMO支持持续时间的人（5[3-9]天vs.12[3-22]天,P=0.004)。支持时间短的患者撤机成功率明显较高;58%(29/50),40%（10/25），A组16%(4/25)，B,C,分别(P=0.002)。总的来说,支持超过24天（0/11）的患者均未成功脱离VA-ECMO。在多变量逻辑回归分析中，在调整年龄后，支持持续时间的长度与成功断奶独立相关，性别,潜在的病因，和左心室射血分数(比值比，0.813[每3天]；95%置信区间，0.679-0.914；P=0.025）。
结论：在心源性休克患者中，VA-ECMO支持持续时间长与断奶成功率低显著相关。需要VA-ECMO超过1周的患者应开始考虑晚期HF治疗或退出治疗。
结果：2013年1月至2023年6月进行了回顾性单中心队列研究。它包括100例接受VA-ECMO治疗的心源性休克患者。院外心脏骤停的患者被排除在外。主要结局是从VA-ECMO成功断奶(即，VA-ECMO拔管和存活出院)。分析了支持持续时间与断奶成功率之间的关系。根据ECMO支持时间将患者分为三组：A组（≤7天），B组（8-14天），和C组（≥15天）。采用多变量logistic回归分析评价支持持续时间对VA-ECMO成功断奶的影响。中位年龄为67岁,73%的研究参与者是男性。心源性休克的病因如下：急性心肌梗死，50;暴发性心肌炎，19；心肌病，15；心脏瓣膜病，8、其他8.75名患者(75%)试图戒断VA-ECMO，67开始拔管。总的来说,43例（43%）患者成功脱离VA-ECMO。ECMO支持持续时间的中位数为8[3-15]天。与那些成功进行ECMO拔管的人相比，那些没有明显更长的VA-ECMO支持持续时间的人（5[3-9]天vs.12[3-22]天,P=0.004)。支持时间短的患者撤机成功率明显较高;58%(29/50),40%（10/25），A组16%(4/25)，B,C,分别(P=0.002)。总的来说,支持超过24天（0/11）的患者均未成功脱离VA-ECMO。在多变量逻辑回归分析中，在调整年龄后，支持持续时间的长度与成功断奶独立相关，性别,潜在的病因，和左心室射血分数(比值比，0.813[每3天]；95%置信区间，0.679-0.914；P=0.025）。
结论：在心源性休克患者中，VA-ECMO支持持续时间长与断奶成功率低显著相关。需要VA-ECMO超过1周的患者应开始考虑晚期HF治疗或退出治疗。
