A multicentre retrospective cohort assessed sex differences in vasopressor de-escalation after arginine vasopressin initiation in 193 patients with cardiogenic shock supported by VA-ECMO. Successful de-escalation at 48 hours, defined as norepinephrine equivalent dose below 0.25 µg/kg/min, occurred in 32% of women versus 49% of men (p=0.023). Male sex was independently associated with success (adjusted odds ratio 2.08, 95% confidence interval 1.07–4.15). In subgroup findings, excess failure risk was confined to postmenopausal women aged 55 years or older (adjusted odds ratio 2.75, 95% confidence interval 1.32–5.93).
Sex was associated with vasopressor de-escalation after vasopressin initiation in this VA-ECMO cohort. These hypothesis-generating findings do not establish sex-specific treatment effects or a survival benefit.
Study limitation: Retrospective associations remain vulnerable to confounding; the menopause subgroup is exploratory, and vasopressor de-escalation is a surrogate endpoint.
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