Concomitant IABP Improves ECMO Weaning: A Single-Center Experience

Background: Utilization of extracorporeal membrane oxygenation (ECMO) is increasing regardless of indication. In patients with deemed recovery, several concepts were described for potential weaning-strategies. However, weaning off ECMO support requires patient-adjusted hemodynamic management and therapy. Therefore, we aimed to investigate predictive factors of successful ECMO weaning.

Method: We retrospectively analyzed data from 258 patients treated with ECMO at our tertiary ECMO center from January 2006 until January 2017. To analyze factors associated with successful weaning, patients were divided into weaning and no-weaning groups.

Results: A total of 136 patients (53%) were successfully weaned off ECMO support. Demographics and comorbidities showed no difference. Further laboratory tests prior ECMO implantation as pH, hemoglobin, and lactate revealed no difference. In contrast, lactate values during ECMO circulation were significantly lower in the weaned group (1 h and 6 h and 12 h and 24 h and 36 h post-ECMO implantation: p < 0.001). Additionally, the rate of concomitant intra-aortic balloon pump (IABP) was significantly higher in weaned patients (100 (74%) weaning versus 69 (57%) no-weaning; p = 0.013). Despite weaning off ECMO support, 49% of weaned patients died during the hospital stay. ECMO duration (hours), length of stay at the ICU (days) and ventilation time (days) were significantly higher in the weaned group. Corresponding to the prolonged duration of the ECMO, the ICU stay and ventilation time, the incidence of neurological complications and sepsis were significantly higher (p < 0.001).

Conclusion: Simultaneous IABP support during ECMO circulation might beneficially impact ECMO weaning rate. Lactate levels should always be incorporated into diagnostics and therapeutic measures to address full recovery of hemodynamics and to improve survival after weaning off ECMO support.

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Artikel online veröffentlicht:
03. Februar 2022