Abstract 4142145: The Usefulness of Left Atrial Strain for Successful Weaning from Venoarterial Extracorporeal Membrane Oxygenator

Backgrounds: Echocardiographic predictors of successful weaning from venoarterial extracorporeal membrane oxygenator (VA-ECMO) have been fully elucidated although previous studies reported echocardiographic parameters of left ventricular systolic function as a weaning indicator. Therefore, we investigated whether left atrial (LA) strain was associated with successful weaning from VA-ECMO. Methods: A total of 144 patients with profound cardiogenic shock who received VA-ECMO between March 2016 and March 2024 were enrolled from a single-center prospective registry. The ECMO flow study assessed cardiac recovery before the weaning trial. The flow was decreased by around 30% of the initial flow for 15 minutes. We assessed conventional echocardiographic parameters, LA strain, and left ventricular global longitudinal strain (LV GLS) both at baseline and after flow reduction, respectively. The primary outcome was successful ECMO weaning. Results: After excluding 24 patients with poor image quality, 120 patients were finally analyzed. Among them, 70 patients (58.3%) had successful weaning from VA-ECMO. During the ECMO flow study, aortic velocity time integral (13.1±7.1cm vs 9.7±4.0cm, p=0.002), left ventricular ejection fraction (35.4±12.3% vs 25.2±10.7%, p, and mitral s’ velocity (7.5±2.7 vs 5.4±2.0 cm/sec, pechocardiographic parameters for ECMO weaning, were higher in the weaning success group compared to the weaning failure group at ECMO minimal flow. The increase of LA strain (p in the successful weaning group was significantly higher than in the failed group according to the reduction of flow contrast to left ventricular ejection fraction (p=0.264) and mitral s’ velocity (p=0.001). LA strain (AUROC=0.789, 95% CI 0.705-0.872, pat minimal flow had a predictive performance for successful ECMO weaning comparable to that of LVEF(AUROC=0.750, 95% CI 0.660-0.839, p at minimal flow. Conclusions: LA strain at minimal ECMO flow might be useful as an indicator of successful weaning from VA ECMO along with conventional echocardiographic parameters. Keyword: extracorporeal membrane oxygenator; weaning; left atrial strain