Meta-analysis of the predictive value of critical care echocardiography for weaning outcomes in patients with VA-ECMO-assisted cardiogenic shock.

OBJECTIVE

This study aimed to evaluate the predictive value of critical care echocardiographic parameters for weaning outcomes in patients receiving venoarterial extracorporeal membrane oxygenation (VA-ECMO) for cardiogenic shock.

METHODS

A comprehensive literature search was conducted across PubMed, Embase, Cochrane Library, Web of Science, Scopus, and CINAHL from inception to December 2025. Studies reporting echocardiographic predictors of VA-ECMO weaning outcomes were included. A two-component analytical approach was applied, which pooled standardized mean differences for association analyses and used bivariate random-effects modeling (Reitsma method) for diagnostic accuracy.

RESULTS

A total of 37 studies encompassing 3,458 patients were analyzed. Aortic valve opening status exhibited the highest discriminative ability (AUC = 0.88, 95% CI: 0.82-0.93), followed by left ventricular outflow tract velocity-time integral (AUC = 0.85, 95% CI: 0.81-0.88), tissue Doppler-derived mitral annular systolic velocity (AUC = 0.81, 95% CI: 0.76-0.86), and left ventricular ejection fraction (AUC = 0.79, 95% CI: 0.75-0.83). Provisional reference thresholds, derived primarily from studies using a 48-h decannulation definition, included LVEF 20-25%, LVOT-VTI ≥ 10 cm, and TAPSE ≥17 mm; these should be interpreted as exploratory rather than confirmatory.

CONCLUSION

This meta-analysis describes a hierarchy of echocardiographic parameters for predicting VA-ECMO weaning success and provides provisional reference thresholds that may inform-but do not replace - individualized clinical judgment in cardiogenic shock management.