Association Between Preadmission β-Blocker Use and Venoarterial Extracorporeal Membrane Oxygenation Weaning Failure in Patients With Cardiogenic Shock

BACKGROUND: Preadmission β-blocker (BB) use may convey cardioprotective effects after onset of cardiogenic shock (CS). It is unknown whether this also holds for patients with the most severe forms of CS receiving venoarterial extracorporeal membrane oxygenation (V-A ECMO) support.

METHODS: We conducted a multicenter observational cohort study including adult patients supported by V-A ECMO for severe CS between February 2018 and January 2025. Patients who had taken BBs within 48 hours before ECMO initiation as part of their home medication were compared with those who had not. The primary end point was ECMO weaning failure at 30 days; a composite of death, ongoing or renewed ECMO support, or the need for heart replacement therapy.

RESULTS: A total of 307 patients were included in the study, of whom 87 (28.3%) were in the BB group. ECMO weaning failure occurred in 40 patients (46.0%) in the BB group compared with 126 (57.3%) patients in the non-BB group (log-rank test, P=0.08). No significant difference was seen in the trend of hemodynamic and metabolic parameters during ECMO support. Multivariable Cox proportional hazards regression analyses showed that preadmission BB use was significantly associated with a decreased risk for ECMO weaning failure (hazard ratio, 0.61 [95% CI, 0.40-0.91]).

CONCLUSIONS: In this study, BB use before the onset of severe CS in patients supported by V-A ECMO was significantly associated with lower inotrope requirements and lower rates of ECMO weaning failure. Future studies are needed to confirm these results and investigate the potential and feasibility of continuing low dosages of BBs during CS.

REGISTRATION: URL: https://www.clinicaltrials.gov; Unique Identifier: NCT05444764.