Background: The use of temporary mechanical circulatory support (tMCS) has revolutionized the management of cardiogenic shock (CS). However, standardized readiness-to-explant criteria for venoarterial extracorporeal membrane oxygenation (VA-ECMO) have not been established.

Methods and Results: We performed a retrospective analysis of 37 patients with CS who were explanted from VA-ECMO at Okayama University Hospital from December 2018 to May 2024 to evaluate the diagnostic performance of each readiness-to-explant criterion for explant success or failure. Explant success was defined as 30-day survival without re-insertion of MCS. Hemodynamic parameters were assessed at explant, weaning (1.0 to 1.5 L/min), and the off test (5 min). We assessed the predictive performance among parameters in successful or unsuccessful explantation of VA-ECMO using receiver operative characteristic curve analysis. The pulmonary artery catheter (PAC) criteria (pulmonary artery wedge pressure ≤18 mmHg, central venous pressure ≤12 mmHg, and cardiac index ≥2.2 L/min/m²) at the off test showed the highest predictability for successful explantation of VA-ECMO (area under the receiver operating characteristics curve 0.83; 95% confidence interval 0.71–0.96). The sensitivity, specificity, positive predictive value, and negative predictive value of the PAC criteria were 67%, 100%, 100%, and 38%, respectively.

Conclusions: Our results suggest that the PAC criteria at the off test may be the most appropriate algorithm for predicting successful explantation of VA-ECMO. Further prospective studies are needed to validate the present findings and to establish standardized VA-ECMO explantation practices.