This observational cohort included 440 adults with severe cardiogenic shock receiving VA ECMO at six Dutch hospitals. ECMO weaning failure occurred in 235 patients (53.4%). This endpoint comprised death, ongoing ECMO support, or heart replacement therapy up to 30 days. In adjusted joint models, higher cumulative inotropic exposure was associated with greater risks of weaning failure (HR 1.04; 95% CI 1.00–1.07) and 30-day mortality (HR 1.04; 95% CI 1.01–1.08). Inotropic support remained largely unchanged in the days after VA ECMO initiation.
Greater cumulative inotropic exposure during VA ECMO was associated with worse outcomes, but this observational study does not establish that reducing inotropes improves recovery or survival.
Study limitation: Residual confounding by illness severity and treatment indication may explain the associations; the abstract does not specify the exposure increment underlying hazard ratios.
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