1097 predictors of weaning from temporary mechanical circulatory support in patients with cardiogenic shock

Abstract Introduction In cardiogenic shock (CS) patients with temporary mechanical circulatory support (TMCS) the weaning process is crucial to verify patients’ myocardial recovery or device dependency. To date, there are no specific guidelines on weaning strategies. Hypothesis We investigated clinical predictors of successful weaning from TMCS and developed with them a novel prognostic scoring system. Methods Eighty CS patients (62.5 ± 11.8 years, 86.2% male, 63.7% with ACS) with Impella support were evaluated. Hemodynamic, echocardiographic and laboratory data were collected at admission (T0), 24 (T1), 48 (T2), 96 (T3) hours after TMCS implantation. CS patients were classified according to successful or unsuccessful weaning, defined as hemodynamic/myocardial recovery, and death/need for LVAD/heart transplant, respectively. Independent predictors of weaning and their discriminating cut-off values were identified. Finally, a prognostic weaning score (W-Score) was derived. Results Thirty-eight (47.5%) CS patients showed successful (SW-group) while 42 (52.5%) unsuccessful (UW-group) weaning from TMCS. Clinical characteristics were similar between the two groups. SW-group showed higher T1, T2, T3 LVEF (p=0.013, p=0.001, p=0.001), T1 CPO (p=0.04), T2 MAP (p=0.019) and lower T1, T2 inotropic score values (p=0.001, p=0.001), T2 HR and PCWP (p=0.01, p=0.008), T1 and T3 creatinine (p=0.018, p=0.009), lactate (p=0.009, p=0.002) and NT-proBNP (p=0.017, p=0.001). T1 LVEF, NT-proBNP and inotropic score together with T3 creatinine and lactate resulted independent predictors of SW (p<0.05). T1 LVEF ≥ 10%, T1 inotropic score ≤ 8, T1 NT-proBNP ≤ 8068 ng/L, T3 lactate ≤ 1,59 mmol/L, T3 creatinine ≤ 1,76 mg/dl identified patients with SW (overall, AUC ≥0.7, p<0.05). W-Score was developed enabling SW with a cut-off score ≥ 7 (80% sensitivity, 85% specificity, AUC 0.92, p <0.001). Conclusions W-Score, based on T1 LVEF/inotropic score/NT-proBNP, T3 creatinine/lactate values may be useful to identify CS patients undergoing successful weaning from TMCS.