Pragmatic assessment of VA-ECMO decannulation readiness after extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest

Authors

• Garima Dahiya, Division of Critical Care Cardiology, Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA; Division of Cardiovascular Disease, University of Minnesota, Minneapolis, Minnesota, USA. Electronic address: dahiya.garima@mayo.edu.
• Laith Alhuneafat, Division of Cardiovascular Disease, University of Minnesota, Minneapolis, Minnesota, USA.
• Jason Bartos, Division of Cardiovascular Disease, University of Minnesota, Minneapolis, Minnesota, USA.
• Steffen Ventz, Division of Biostatistics and Health Data Science, University of Minnesota, Minneapolis, Minnesota, USA.
• Daniel Gonzalez, Advocate Health - MidwestFollow
• Meagan Nowariak, University of Minnesota Medical School, Minneapolis, Minnesota, USA.
• Guido Tavazzi, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.
• Ziou Jiang, Biostatistical Design and Analysis Center, University of Minnesota Clinical and Translational Science Institute, Minneapolis, Minnesota, USA.
• Gregory Mello, Advocate Health - Midwest
• Jalal Agakishi, Advocate Health - Midwest
• Natalie Hunninghake, Advocate Health - Midwest
• Alejandra Gutierrez Bernal, Division of Cardiovascular Disease, University of Minnesota, Minneapolis, Minnesota, USA.
• Demetris Yannopoulos, Division of Cardiovascular Disease, University of Minnesota, Minneapolis, Minnesota, USA.
• Andrea Elliott, Division of Cardiovascular Disease, University of Minnesota, Minneapolis, Minnesota, USA.

Recommended Citation

Dahiya G, Alhuneafat L, Bartos J, et al. Pragmatic Assessment of VA-ECMO Decannulation Readiness After Extracorporeal Cardiopulmonary Resuscitation for Out-of-Hospital Cardiac Arrest. JACC Adv. Published online July 29, 2026. doi:10.1016/j.jacadv.2026.103049

Affiliations

Advocate Christ Medical Center

Abstract

Background: Readiness for venoarterial-extracorporeal membrane oxygenation (VA-ECMO) decannulation after extracorporeal cardiopulmonary resuscitation (ECPR) for out-of-hospital cardiac arrest (OHCA) remains poorly defined.

Objectives: The objective of the study was to identify bedside clinical variables associated with successful decannulation in OHCA patients treated with ECPR.

Methods: Consecutive OHCA patients treated under the Minnesota Resuscitation Consortium ECPR protocol from December 2015 to March 2023 were analyzed. Hemodynamic, vasoactive medication, echocardiographic, and mechanical circulatory support variables were compared between successful and failed decannulation. Feature importance analysis was conducted using Bayesian additive regression trees and multivariable logistic regression.

Results: Among 390 OHCA ECPR patients, 125 underwent VA-ECMO decannulation; 110 (88%) were successful. Failed decannulations were less likely to have been witnessed arrests (73% vs 100%; P = 0.04) and had lower rates of bystander CPR (36.4% vs 68.6%; P = 0.05). On weaning readiness assessment, left ventricular ejection fraction at lowest VA-ECMO flow (OR: 0.96; 95% CI: 0.92-0.99; P = 0.024), arterial pulsatility (OR: 0.95; 95% CI: 0.90-0.99; P = 0.027), Vasoactive inotrope score (OR: 1.16; 95%-CI: 1.04-1.32; P = 0.013) and days on VA-ECMO support (OR: 1.40; 95%-CI: 1.13-1.79; P = 0.003) were significantly associated with decannulation success. A Bayesian additive regression trees model incorporating left ventricular ejection fraction, pulsatility, vasoactive-inotrope score, predecannulation VA-ECMO flow, and concomitant intra-aortic balloon pump support predicted success with an area under the curve of 0.91.

Conclusions: Our study identifies several pragmatic variables, noninvasive and accessible at the bedside that are predictive of successful decannulation among OHCA patients undergoing ECPR. Prospective validation of a composite decannulation prediction score incorporating these variables is warranted to aid decision-making.

Document Type

Article

PubMed ID

42526189