Background: Although extracorporeal membrane oxygenation (ECMO) is an integral part of a robust cardiogenic shock program, it is associated with high mortality. The optimal strategy for weaning from ECMO is unknown. We undertook this study to better understand the use of ECMO for acute cardiogenic shock.

Methods: We conducted a retrospective review of all cardiogenic shock patients at our facility from 2021-2023. Patients with mixed cardiogenic shock were included. The primary outcome was survival to discharge.

Results: From 2021-2023, 284 shock patients were treated by our shock team. A total of 91 (32.16%) patients were treated medically while 192 (67.84%) were treated with temporary mechanical circulatory support (tMCS), including 65 (22.89%) patients who were treated with ECMO. Of those treated with ECMO, 33 (50.77%) had another form of tMCS prior to ECMO cannulation, 43 (67.19%) utilized tMCS as a left ventricular vent while one ECMO, and 34 (53.97%) utilized Impella as a weaning platform for ECMO decannulation. Cardiogenic shock patients requiring ECMO support had lower survival compared to those who did not (35.38% vs. 65.30%, p<0.001) and this survival was unaffected by left ventricular venting (39.53% vs. 28.57%, p=0.39). However, patients utilizing Impella as a weaning platform from ECMO had significantly improved survival (55.88% vs. 13.79%, p=0.001) compared to those who did not wean to tMCS.

Implications: Although the need for ECMO is associated with an increased mortality in cardiogenic shock, the utilization of Impella as a weaning platform may mitigate some of the risks. Further investigation is warranted.