{
  "abstract": "OBJECTIVES:: During venoarterial extracorporeal membrane oxygenation (VA ECMO), organ perfusion no longer entirely depends on native cardiac output, which may reduce the therapeutic advantage of inotropic drugs relative to their risks. We hypothesized that, in this setting, higher cumulative inotropic exposure would be associated with impaired cardiac recovery.\n\nDESIGN:: Observational cohort study on the effects of longitudinal inotropic exposure during VA ECMO support. Temporal changes in inotropic support during VA ECMO support were evaluated. Cumulative inotropic exposure per day during VA ECMO support was calculated using the area under the curve of a standardized inotropic score. These cumulative inotropic scores were associated with the risk of ECMO weaning failure up to 30 days (a composite of death, ongoing need for ECMO support, or the need for heart replacement therapy), mortality, and complications, using joint modeling techniques.\n\nSETTING:: Six hospitals in the Netherlands.\n\nPATIENTS:: Adult patients with severe cardiogenic shock (CS) receiving VA ECMO support between 2018 and 2024.\n\nINTERVENTIONS:: None.\n\nMEASUREMENTS AND MAIN RESULTS:: Out of 440 patients with various causes of CS, 235 patients (53.4%) developed ECMO weaning failure. Inotropic support remained largely unchanged in the days following VA ECMO initiation. Adjusted joint models showed that a higher cumulative inotropic exposure during VA ECMO support was associated with an increased risk for ECMO weaning failure (hazard ratio [HR], 1.04; 95% CI, 1.00–1.07), 30-day mortality (HR, 1.04; 95% CI, 1.01–1.08), arrhythmias (HR, 1.05; 95% CI, 1.01–1.08), and protracted lactate clearance (HR, 0.96; 95% CI, 0.92–0.99).\n\nCONCLUSIONS:: In patients requiring VA ECMO support for refractory CS, inotropic support is often maintained at similar levels after ECMO initiation. Higher cumulative inotropic exposure was associated with an increased risk for ECMO weaning failure. Prospective studies are needed to investigate whether inotropes can be tapered or even stopped and whether such a strategy could improve cardiac recovery.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Intensive Care Adults, Erasmus Medical Center, Rotterdam, The Netherlands.",
    "Department of Cardiology, Thorax Center, Cardiovascular Institute, Erasmus Medical Center, Rotterdam, The Netherlands.",
    "Department of Intensive Care, University Medical Center Utrecht, Utrecht, The Netherlands.",
    "Department of Cardiovascular and Respiratory Physiology, University of Twente, Enschede, The Netherlands.",
    "Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.",
    "Department of Intensive Care, Leiden University Medical Center, Leiden, The Netherlands.",
    "Department of Intensive Care, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.",
    "Department of Intensive Care, Sint Antonius Hospital, Nieuwegein, The Netherlands.",
    "Department of Intensive Care, Isala, Zwolle, The Netherlands.",
    "Department of Epidemiology & Health Economics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.",
    "Department of Cardiology, Copenhagen University Hospital–Rigshospitalet, Denmark.",
    "Departments of Biostatistics, Erasmus Medical Center, Rotterdam, The Netherlands."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 20,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Myrthe P.J. van Steenwijk"
    },
    {
      "affs": [
        0,
        2
      ],
      "name": "Lara C.A. Pladet"
    },
    {
      "affs": [
        0
      ],
      "name": "Atreyu van Esch"
    },
    {
      "affs": [
        0
      ],
      "name": "Hong Jun Shi"
    },
    {
      "affs": [
        2,
        3
      ],
      "name": "Dirk W. Donker"
    },
    {
      "affs": [
        4
      ],
      "name": "Yannick Taverne"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Jeroen J.H. Bunge"
    },
    {
      "affs": [
        5
      ],
      "name": "Carlos V. Elzo Kraemer"
    },
    {
      "affs": [
        5
      ],
      "name": "Jacinta J. Maas"
    },
    {
      "affs": [
        6
      ],
      "name": "Leon J. Montenij"
    },
    {
      "affs": [
        6
      ],
      "name": "Luuk C. Otterspoor"
    },
    {
      "affs": [
        7
      ],
      "name": "Erik Scholten"
    },
    {
      "affs": [
        8
      ],
      "name": "Laurien van Koppenhagen"
    },
    {
      "affs": [
        9
      ],
      "name": "Joost van Rosmalen"
    },
    {
      "affs": [
        0
      ],
      "name": "Diederik Gommers"
    },
    {
      "affs": [
        1
      ],
      "name": "Alina A. Constantinescu"
    },
    {
      "affs": [
        1
      ],
      "name": "Rudolf A. de Boer"
    },
    {
      "affs": [
        10
      ],
      "name": "Jacob E. Møller"
    },
    {
      "affs": [
        11
      ],
      "name": "Dimitris Rizopoulos"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Christiaan L. Meuwese",
      "orcid": "0000-0002-1901-1653"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/3vhdntznsrdqj.bib",
  "cited_by": 1,
  "doi": "10.1097/ccm.0000000000007338",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13722429/",
  "id": "3vhdntznsrdqj",
  "issns": [
    "0090-3493",
    "1530-0293"
  ],
  "landing_url": "https://doi.org/10.1097/ccm.0000000000007338",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Clinical Investigation"
    ],
    [
      "openalex",
      "2204|Mechanical Circulatory Support Devices"
    ]
  ],
  "openalex": "W7214348498",
  "pdf_url": null,
  "pmcid": "PMC13722429",
  "pmid": "42809661",
  "published": "2026-09-25",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/3vhdntznsrdqj.ris",
  "sources": [
    {
      "first_seen": "2026-11-03T12:22:56Z",
      "native_id": "PMC13722429",
      "source": "pmc",
      "url": "https://doi.org/10.1097/ccm.0000000000007338"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "journal-openalex:F27",
      "subfield": "general"
    }
  ],
  "title": "Time-Dependent Effects of Inotropic Exposure During Venoarterial Extracorporeal Membrane Oxygenation Support on the Probability of Extracorporeal Membrane Oxygenation Weaning Failure",
  "title_text": "Time-Dependent Effects of Inotropic Exposure During Venoarterial Extracorporeal Membrane Oxygenation Support on the Probability of Extracorporeal Membrane Oxygenation Weaning Failure",
  "type": "peer-reviewed",
  "updated_at": "2026-11-03T12:22:56Z",
  "url": "https://research.draconitic.com/paper/3vhdntznsrdqj",
  "venue": "Critical Care Medicine",
  "versions": []
}