A Novel Predictive Score Model for Successful Weaning From Mechanical Circulatory Support in Patients With Cardiogenic Shock

Background

Clinical evidence regarding predictors of successful weaning from mechanical circulatory support (MCS) is lacking. This study aimed to create a simple risk score to predict successful weaning from MCS in patients with cardiogenic shock.

Methods and Results

This retrospective single-center cohort study included 114 consecutive patients with cardiogenic shock treated with venoarterial extracorporeal membrane oxygenation or IMPELLA between January 2013 and June 2023. Patients with out-of-hospital cardiac arrest were excluded. The primary end point was successful weaning from MCS, defined as successful decannulation without the need for MCS reimplantation and survival to discharge. Multivariable logistic regression with a stepwise variable selection was performed to generate the prediction model. We first developed a general weaning score model, and then created a simple version of the score model using the same variables. Fifty-five patients were weaned from MCS successfully. The following variables measured during weaning evaluation were selected as the components of the weaning score model: acute myocardial infarction (AMI), mean blood pressure, left ventricular ejection fraction (LVEF), lactate level, and QRS duration. According to the results, we conducted a novel weaning score model to predict successful weaning from MCS: 1.774 – 2.090 × (AMI) + 0.062 × [mean blood pressure (mm Hg)] + 0.139 × [LVEF (%)] – 0.322 × [Lactate (mg/dL)] – 0.066 × [QRS (ms)]. The following variables were selected as the components of the simple version of the weaning score model: AMI, mean blood pressure of ≥80 mm Hg, lactate of <10 mg/dL, QRS duration of ≤95 ms, and LVEF of >35%.

Conclusions

We developed a simple model to predict successful weaning from MCS in patients with cardiogenic shock.