AIMS: This study aimed to investigate incidence and predictors of weaning failure and in-hospital death after successful weaning from veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in patients with cardiogenic shock (CS). METHODS AND RESULTS: Overall, 685 patients with CS treated with VA-ECMO from 23 tertiary care centres in 7 countries were analysed (median age 57 [interquartile range 49-66] years, 542 [79.1%] male, median lactate 7.6 [interquartile range 4.1-12.7] mmol/L). The cause of CS was acute myocardial infarction in 438 (63.9%) patients, and 431 (62.9%) patients presented with cardiac arrest. A total of 410 patients (59.9%) were successfully weaned from VA-ECMO, whereas in 275 patients (40.1%) weaning failed (i.e. patients died on or within 48 h after VA-ECMO support). Of the successfully weaned patients, 150 (36.6%) died before hospital discharge. On multivariable logistic regression, predictors for both patient groups varied: age (per 10 years, odds ratio [OR] 1.49, 95% confidence interval [CI] 1.25-1.76; p < 0.001) and cardiac arrest before VA-ECMO implantation (OR 1.64, 95% CI 1.01-2.64; p = 0.04) were associated with weaning failure, whereas lactate clearance within 24 h after VA-ECMO initiation was associated with successful weaning (OR 0.21, 95% CI 0.1-0.44; p < 0.001). In-hospital death after successful weaning was more likely with higher age (per 10 years, OR 1.56, 95% CI 1.24-1.97; p < 0.001), renal replacement therapy (OR 2.56, 95% CI 1.4-4.68; p = 0.002) and bleeding events (OR 2.93, 95% CI 1.4-6.14; p = 0.004). CONCLUSION: Weaning from VA-ECMO fails in 40% of patients treated with VA-ECMO for CS. When successful, survival after VA-ECMO weaning mostly depends on age and the incidence of device- and shock-related complications.

Cardio Center Humanitas Clinical and Research Center IRCCS Rozzano Italy

Cariovascular Center Aalst OLV Hospital Aalst Belgium

Center for Population Health Innovation University Heart and Vascular Center Hamburg University Medical Center Hamburg Eppendorf Hamburg Germany

Department Cardiothoracic and Vascular Anesthesia and Intensive Care AO SS Antonio e Biagio e Cesare Arrigo Alessandria Italy

Department for Internal Medicine and Cardiology Technische Universität Dresden Heart Centre Dresden University Hospital Dresden Germany

Department of Cardiology and Angiology University Heart Center Freiburg Bad Krozingen Freiburg Germany

Department of Cardiology and Vascular Medicine West German Heart and Vascular Center University Hospital Essen Essen Germany

Department of Cardiology Angiology and Intensive Care Medicine DHZC Berlin Campus Benjamin Franklin Berlin Germany

Department of Cardiology IKEM Prague Czech Republic

Department of Cardiology Paracelsus Medical University Nürnberg Nürnberg Germany

Department of Cardiology University Heart and Vascular Center Hamburg Hamburg Germany

Department of Cardiothoracic Surgery University Heart and Vascular Center Hamburg Hamburg Germany

Department of Clinical Surgical Diagnostic and Paediatric Sciences University of Pavia Italy; Anesthesia and Intensive Care Fondazione Policlinico San Matteo Hospital IRCCS Pavia Italy

Department of Internal Medicine 1 University Hospital Jena Jena Germany

Department of Internal Medicine 1 University Hospital Würzburg Würzburg Germany

Department of Internal Medicine 2 University Medical Center Regensburg Regensburg Germany

Department of Internal Medicine and Cardiology Heart Center Leipzig at University of Leipzig and Leipzig Heart Science Leipzig Germany

Department of Medicine 1 University Hospital LMU Munich Munich Germany

Department of Perioperative Medicine St Bartholomew's Hospital London UK

Division of Cardiology Department of Internal Medicine Medical University of Graz Graz Austria

Division of Cardiology Pulmonology and Vascular Medicine Medical Faculty University Duesseldorf Duesseldorf Germany

German Center for Cardiovascular Research Partner site Hamburg Kiel Lübeck Hamburg Germany

IRCCS Fondazione Don Gnocchi ONLUS Santa Maria Nascente Milan Italy

Medizinische Klinik 2 Kliniken Nordoberpfalz AG Weiden Germany

University Heart Center Lübeck University Hospital Schleswig Holstein Lübeck Germany

University Medical Center Hamburg Eppendorf Department of Intensive Care Medicine Hamburg Germany

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