Punn et al identified hemodynamic and echocardiographic predictors of failed weaning from venoarterial extracorporeal membrane oxygenation (vaECMO). Diminished contractility and underlying disease are mechanisms for weaning failure. The authors are from multiple institutions in the United States.
Patient selection: pediatric patient on venoarterial ECMO for cardiac dysfunction
Patients who fail weaning may:
(1) require heart transplantation
(2) require placement of a ventricular assist device
(3) die
Predictors of failed weaning:
(1) longer duration of ECMO (>= 7 days)
(2) ejection fraction <= 41%
(3) systemic outflow tract velocity*time integral (VTI) <= 7.9 cm
(4) post-wean mitral regurgitation severity
(5) elevated post-wean central venous pressure
where:
• VTI is a surrogate measure of stroke volume.
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