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Updated: Sep 23, 2025
Point-of-Care Ultrasound for Peripheral Veno-Arterial Extracorporeal Membrane Oxygenation Without Left Ventricular Venting
Published on: January 17, 2025
Cardiac Dysfunction Biomarkers Are Associated With Potential for Successful Separation From Extracorporeal Membrane
Kristen Coletti1, Megan Griffiths2, Melanie Nies2
1From the Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Insights
Cardiac dysfunction biomarkers, especially ST2, may help determine when to remove children from extracorporeal membrane oxygenation (ECMO). Higher ST2 levels at cannulation indicated difficulty separating from ECMO.
Area of Science:
- Biomedical research
- Cardiology
- Pediatric critical care
Background:
- Extracorporeal membrane oxygenation (ECMO) is a life-support measure for critically ill children.
- Identifying biomarkers to guide ECMO weaning is crucial for patient management.
- Cardiac dysfunction assessment is vital during ECMO support.
Purpose of the Study:
- To investigate the association between specific biomarkers and the ability to separate from venoarterial ECMO in pediatric patients.
- To evaluate the utility of Suppression of tumorigenicity 2 (ST2), N-terminal pro-B-type natriuretic peptide (NT-proBNP), galectin-3, and endostatin in predicting ECMO separation.
Main Methods:
- Prospective observational pilot study of 50 pediatric patients (0 to <18 years) on venoarterial ECMO.
- Measurement of plasma ST2, NT-proBNP, galectin-3, and endostatin concentrations at cannulation and during ECMO.
- Comparison of biomarker levels between patients who successfully separated from ECMO and those who could not.
Main Results:
- Higher ST2 concentrations at cannulation were observed in patients unable to separate from ECMO (395.3 ng/mL vs. 207.4 ng/mL, p=0.012).
- ST2 and NT-proBNP levels significantly decreased from the first to the last ECMO day in successfully weaned patients.
- Endostatin levels increased significantly in both groups, while galectin-3 showed no association with ECMO separation.
Conclusions:
- Cardiac dysfunction biomarkers, particularly ST2, may assist in decannulation decisions for pediatric ECMO patients.
- ST2 shows potential as a predictive marker for ECMO separation success.
- Further validation in larger studies is warranted to confirm these findings.
Abstract:
Biomarkers of cardiac dysfunction may aid in decision making about organ recovery and optimal timing of separation from extracorporeal membrane oxygenation (ECMO). We conducted a prospective observational study of children from 0 to <18 years who underwent ECMO between 7/2010 and 6/2015 in a single center. In this pilot study, we aimed to determine whether Suppression of tumorigenicity 2 (ST2), N -terminal pro-B-type natriuretic peptide (NT-proBNP), galectin-3, and endostatin were associated with ability to separate from ECMO. Fifty neonatal and pediatric participants supported on venoarterial ECMO were included (median age 13 days, 50% male). Twelve (24%) participants were unable to separate from extracorporeal support. Plasma ST2 concentrations at cannulation were higher in children who were ultimately unable to separate versus those who successfully separated from ECMO (median 395.3 ng/mL vs. 207.4 ng/mL, p = 0.012). ST2 and NT-proBNP concentrations decreased significantly from the first to the last ECMO day in patients successfully separated from ECMO ( p < 0.0001 and p = 0.017, respectively). Endostatin concentrations increased significantly from the first to the last ECMO day in both groups. Galectin-3 concentrations were not associated with the ability to separate from ECMO. Cardiac dysfunction biomarkers, particularly ST2, may aid in decannulation decision-making in pediatric ECMO patients. These results should be validated with a larger study.
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