• Viet-Dung Duong, Chadi Aludaat, Geoffrey Kouadri, Vincent Scherrer, Thomas Clavier, Zoe Demailly, Vincent Compère, Nathalie Rey, Jean Selim, and Emmanuel Besnier.
• Department of Anesthesiology and Critical Care, University School of Medicine, Rouen University Hospital, Rouen, France.
• J. Cardiothorac. Vasc. Anesth. 2025 Feb 1; 39 (2): 429436429-436.

ObjectiveFew reliable tools exist to predict weaning patient outcomes from venoarterial extracorporeal membrane oxygenation (ECMO; VA-ECMO). Pulmonary artery pulse pressure indexed on right atrial pressure (PAPi) reflects the ventricle-pulmonary coupling and may be representative of right ventricular recovery. Radial artery pulse pressure (rPP) may be representative of left ventricular recovery. We intended to explore the usefulness of these indices in the weaning from VA-ECMO.DesignRetrospective cohort study.SettingSingle center in a tertiary university hospital.ParticipantsPatients benefiting from a VA-ECMO for all-cause refractory cardiogenic shock between 2017 and 2021. Non-inclusion criteria were minor/pregnant patients and ECMO within 48 hours. Univariate and multivariate logistic regression analyses explored the relationship between PAPi and rPP with weaning success.InterventionsWe explored the association between the pulmonary artery pulse pressure indexed on PAPi, rPP, and the success of weaning from VA-ECMO.Measurements And Main ResultsWe included 124 patients for rPP analysis and 82 patients for PAPi analysis. Higher rPP and PAPi (50.43 v 26.3 mmHg, p < 0.001: 1.78 v 0.88, p < 0.001, respectively) and shorter ECMO duration were associated with weaning success. Areas under ROC for rPP and PAPi were 0.85 and 0.88. The combination of rPP ≥ 40 mmHg and PAPi ≥ 1.09 predicted weaning with a sensitivity of 0.94, specificity of 1.00, positive predictive value of 1.00, and negative predictive value of 0.84.ConclusionHigher PAPi and rPP were predictors of successful weaning from VA-ECMO in this retrospective study.Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.

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