Predictors of Successful Weaning from Venous-Arterial Extracorporeal Membrane Oxygenation in Patients with Cardiogenic Shock Following Acute Myocardial Infarction

Abstract

Objective. To identify clinical, laboratory, and procedural predictors of successful weaning from veno-arterial extracorporeal membrane oxygenation in patients with cardiogenic shock following acute myocardial infarction who underwent percutaneous coronary interventions.Materials and Methods. A single-center retrospective cohort study included 57 consecutive adult patients with acute myocardial infarction complicated by cardiogenic shock who underwent percutaneous coronary interventions under veno-arterial extracorporeal membrane oxygenation between 2020 – 2025. The primary endpoint of the study was successful weaning from extracorporeal membrane oxygenation. Univariate and multivariate logistic regression analyses were used to identify independent predictors. The discriminatory ability of the predictors was assessed using ROC analysis.Results. Successful weaning from extracorporeal membrane oxygenation was achieved in 37 (64.9%) patients. The overall in-hospital mortality rate was 43.8%. Patients who were successfully weaned from extracorporeal membrane oxygenation had significantly lower lactate levels and a lower vasoactive-inotropic index than before the procedure began—5.1 (3.2–7.8) and 7.4 (4.6–10,9) mmol/L (p = 0.041) and 39 (28–52) and 52 (38–68) (p = 0.028), respectively. Intra-aortic balloon counterpulsation was used more frequently in patients with successful weaning than in those with unsuccessful weaning—51.4% and 15.0%, respectively (p = 0.008). A multivariate logistic analysis revealed that lactate levels (odds ratio 0.81 for each 1 mmol/L increase; 95% confidence interval 0.66–0.99; p = 0.041) and the use of intra-aortic balloon counterpulsation (odds ratio 4.12; 95% confidence interval 1.09–15.6; p = 0.034) were independent predictors of successful weaning from extracorporeal membrane oxygenation, whereas the vasoactive-inotropic index, after adjustment, did not retain statistical significance as an independent predictor. Lactate levels demonstrated good prognostic ability (area under the ROC curve 0.76) with an optimal cutoff value of 6.5 mmol/L.Conclusions. Among patients with acute myocardial infarction complicated by cardiogenic shock who underwent percutaneous coronary interventions using veno-arterial extracorporeal membrane oxygenation, the rate of successful weaning reached 64.9%, however, the overall in-hospital mortality remained high at 43.8%. Lower lactate levels and the use of intra-arterial balloon counterpulsation were independently associated with successful weaning from extracorporeal membrane oxygenation.