Kim et al reported criteria for being able to wean a patient from extracorporeal membrane oxygenation (ECMO) placed for refractory cardiogenic shock. The authors are from Samsung Medical Center, Sungkyunkwan University and Ewha Womans University Hospital in Seoul, Korea.
Patient selection: VA-ECMO placed for refractory cardiogenic shock
Weaning test: flow decreased by 30-50% of the initial flow for 15 minutes, with echocardiography performed at baselne and after 15 minutes
Criteria for weanability:
(1) any improvement of lateral e' (early diastolic peak myocardial velocity at lateral mitral annulus; OR 11.6))
(2) improvement in tricuspid S' (systolic) velocity > 10% (OR 23.3)
Number of Criteria
Successful Weaning
Failed Weaning
0
5%
76%
1
18%
20%
2
77%
4%
where sums in columns 2 and 3 equal 100%
Other findings favoring successful weaning:
(1) left ventricular decompression (OR 0.22)
(2) decrease in the ratio E / (lateral e') (OR 18.4)
Performance:
• The area under the ROC curve is 0.93.
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