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Updated: Sep 19, 2025
Point-of-Care Ultrasound for Peripheral Veno-Arterial Extracorporeal Membrane Oxygenation Without Left Ventricular Venting
Published on: January 17, 2025
Unifying Weaning Success Criteria to Bridge the Extracorporeal Membrane Oxygenation Gap: Variations in Determinants
Hibiki Serizawa1, Ginga Suzuki1, Saria Nishioka1
1Critical Care Center, Toho University Omori Medical Center 6-11-1, Omori Nishi, Ota-ku, Tokyo, Japan.
Objective:
To investigate the factors contributing to the "ECMO gap," the discrepancy between successful weaning from venoarterial extracorporeal membrane oxygenation (VA-ECMO) and survival to hospital discharge, using different definitions of successful weaning.
Design:
Single-center retrospective observational study.
Setting:
A tertiary academic medical center intensive care unit.
Participants:
Patients aged ≥18 years who underwent VA-ECMO between January 2018 and June 2023. Patients who died while on ECMO were excluded. Successful weaning from ECMO was defined using two criteria: survival for 48 hours (Definition 1) and independence from mechanical circulatory support (MCS) within 30 days (Definition 2).
Interventions:
None.
Measurements And Main Results:
Multivariate logistic regression analysis was performed to identify factors associated with the ECMO gap for each definition, with Bayesian logistic regression conducted as a sensitivity analysis. Of the 130 ECMO patients, 110 were included in the analysis. Acute myocardial infarction and sepsis-induced cardiogenic shock (SICS) were associated with the ECMO gap under Definition 1. Under Definition 2, age (p = 0.04) was significantly associated with the ECMO gap," while SICS showed a trend toward significance (p = 0.06). Bayesian analysis supported the association between age (odds ratio [95% confidence interval]: 0.08 [0.01-0.16]) and the ECMO gap. SICS showed a possible association (odds ratio [95% confidence interval]: 3.15 [0.26-6.33]); however, the wide credible interval suggests caution in interpretation.
Conclusions:
The factors associated with the ECMO gap vary depending on the definition of successful weaning from ECMO. Specifically, advanced age and sepsis (eg, SICS) may hinder long-term recovery and contribute to the ECMO gap. Standardizing the definition of successful ECMO weaning is essential to improving patient outcomes and refining treatment strategies.
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