This registry study examined 7,654 adults receiving VA ECMO for cardiogenic shock; 3,077 were managed with pulmonary arterial catheters. Haemodynamics were assessed at 24 hours, and the primary outcome was 30-day in-hospital mortality. Catheter use was not significantly associated with lower in-hospital mortality (adjusted OR 0.95, 95% CI 0.897–1.006). Among patients surviving 24 hours, pulmonary artery diastolic pressure above 18 mm Hg was associated with greater in-hospital mortality within 30 days (HR 1.29, 95% CI 1.13–1.46), with consistent associations in subgroups receiving left ventricular mechanical unloading.
Early on-support pulmonary artery diastolic pressure may provide prognostic information during VA ECMO. These observational findings do not establish that lowering pressure or using a catheter improves survival.
Study limitation: Observational associations remain vulnerable to confounding; the pressure analysis was restricted to patients surviving 24 hours.
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