Association Between Pulmonary Artery Pulsatility Index and Radial Artery Pulse Pressure and Successful Separation from Peripheral Veno-Arterial Extracorporeal Membrane Oxygenation: A French Single-Center Retrospective Study From 2017 to 2021

Abstract

ObjectiveFew reliable tools exist to predict outcome of weaning patients from veno-arterial ECMO (VA-ECMO). Pulmonary artery pulse pressure indexed on right atrial pressure (PAPi) reflects the ventricular-pulmonary coupling and may be representative of right ventricle 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, ECMO < 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 right atrial pressure (PAPi), the radial artery pulse pressure (rPP) and the success of weaning from VA-ECMO. Measurements and Main Results124 patients were included for rPP analysis and 82 patients for PAPi analysis. Higher rPP and PAPi (50.43 vs 26.3 mmHg, p<0.001: 1.78 vs 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. ConclusionsHigher pulmonary arterial pulsatility index and radial artery pulse pressure were predictors of successful weaning from VA-ECMO in this retrospective study.