Temporal evolution of arterial pulse pressure trajectories as early predictor of weaning success in venoarterial extracorporeal membrane oxygenation

<b>Introduction:</b> Weaning from venoarterial extracorporeal membrane oxygenation (VA ECMO) remains a major challenge because reliable indicators of cardiac recovery are lacking. Arterial pulse pressure (PP), a simple and continuously measured parameter, has been proposed as a surrogate of myocardial function and a potential predictor of weaning outcome.<b>Methods:</b> In this retrospective study, 265 adult VA ECMO supported cardiogenic shock patients at a Dutch tertiary center were screened between 2011 and 2022, of whom 96 were eligible for analysis (mean age 56 ± 15 years, 32.3% female). Continuous, high-resolution hemodynamic data were analyzed over the first 36 h after ECMO initiation. Two dynamic PP metrics (absolute change and regression slope) were derived and compared between patients who were successfully weaned and those who were not. Associations were tested using mixed-effects models, logistic regression, while accounting for ECMO flow, vasoactive-inotropic score, and heart rate.<b>Results:</b> PP was consistently higher from 12 h onward in successfully weaned patients (45.8%). Dynamic PP metrics showed significant associations with outcome (<i>p</i> < 0.001) and remained independent predictors after adjustment.<b>Conclusion:</b> These findings suggest that an early rise in PP may aid to predict VA ECMO weaning success and supports its use as an accessible, real-time marker of myocardial recovery.