Permissive versus conventional weaning from venovenous ECMO in patients with ARDS: a retrospective cohort study.
5 affiliations
- 1Department of Intensive Care, Institute of Cardiology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France.
- 2Department of Medicine and Surgery, Department of Emergency and Intensive Care, University of Milano-Bicocca, Fondazione IRCCS San Gerardo, Monza, Italy.
- 3Department of Cardiac Surgery and Transplantation, Institute of Cardiology, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, Paris, France.
- 4Sorbonne University, INSERM, UMRS 1166-ICAN, Institute of Cardiometabolism and Nutrition, Paris, France.
- 5Sorbonne University, GRC 30, RESPIRE, Paris, France.
Abstract
Background
Criteria for weaning from venovenous extracorporeal membrane oxygenation (V-V ECMO) in acute respiratory distress syndrome (ARDS) remain poorly standardized. Some patients are decannulated despite persistent abnormalities in respiratory mechanics once oxygenation and carbon dioxide clearance are considered adequate. We aimed to compare outcomes associated with permissive versus conventional V-V ECMO weaning.Methods
We conducted a retrospective single-center cohort study including adult patients with refractory ARDS treated with V-V ECMO between January 2015 and December 2022 who were successfully decannulated while receiving invasive mechanical ventilation. Permissive weaning was defined as ECMO decannulation despite persistence of at least one of the following criteria during the sweep gas-off trial: plateau pressure ≥30 cmH₂O, driving pressure ≥20 cmH₂O, positive end-expiratory pressure ≥15 cmH₂O, or tidal volume ≤5 mL/kg predicted body weight. The primary outcome was 90-day mortality after ECMO decannulation. Secondary outcomes included liberation from mechanical ventilation within 90 days, analyzed using competing-risk models with death as a competing event. Associations with mortality were assessed using landmark Cox proportional hazards models anchored at decannulation.Results
Among 469 patients treated with V-V ECMO, 280 successfully decannulated patients were included; 117 (42%) underwent permissive weaning and 163 (58%) conventional weaning. Baseline characteristics were broadly similar, although body mass index was higher and SARS-CoV-2 ARDS more frequent in the permissive group. Patients undergoing permissive weaning had longer ECMO support (19 [9-37] vs. 12 [6-27] days; p < 0.01). At the sweep gas-off trial, respiratory mechanics remained more impaired in the permissive group, whereas oxygenation parameters were comparable. In landmark analysis, permissive weaning was associated with higher 90-day mortality in both univariable (hazard ratio [HR] 3.53, 95% confidence interval [CI] 1.62-7.66; p < 0.01) and multivariable analyses (adjusted HR 4.45, 95% CI 1.98-9.97; p < 0.01). However, permissive weaning was not associated with delayed liberation from mechanical ventilation by day 90 (adjusted subdistribution HR 0.90, 95% CI 0.70-1.17; p = 0.4).Conclusions
Among patients with severe ARDS successfully decannulated from V-V ECMO, permissive weaning was associated with increased 90-day mortality but not with delayed liberation from mechanical ventilation.
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BibTeX
@article{moyon2026permissive,
title = {{Permissive versus conventional weaning from venovenous ECMO in patients with ARDS: a retrospective cohort study.}},
author = {Quentin Moyon and Yoel Benitha and Chahem Harba and Maria Teresa Passarelli and Charles Juvin and Guillaume Lebreton and Juliette Chommeloux and Guillaume Hékimian and Alexandre Coppens and Ouriel Saura and David Levy and Charles-Edouard Luyt and Alain Combes and Matthieu Schmidt},
journal = {Annals of intensive care},
year = {2026},
month = sep,
doi = {10.1016/j.aicoj.2026.100174},
url = {https://europepmc.org/article/MED/42898077},
note = {CC BY},
}
RIS
TY - JOUR
TI - Permissive versus conventional weaning from venovenous ECMO in patients with ARDS: a retrospective cohort study.
AU - Quentin Moyon
AU - Yoel Benitha
AU - Chahem Harba
AU - Maria Teresa Passarelli
AU - Charles Juvin
AU - Guillaume Lebreton
AU - Juliette Chommeloux
AU - Guillaume Hékimian
AU - Alexandre Coppens
AU - Ouriel Saura
AU - David Levy
AU - Charles-Edouard Luyt
AU - Alain Combes
AU - Matthieu Schmidt
PY - 2026
DA - 2026/09/29
JO - Annals of intensive care
DO - 10.1016/j.aicoj.2026.100174
UR - https://europepmc.org/article/MED/42898077
AB - Background Criteria for weaning from venovenous extracorporeal membrane oxygenation (V-V ECMO) in acute respiratory distress syndrome (ARDS) remain poorly standardized. Some patients are decannulated despite persistent abnormalities in respiratory mechanics once oxygenation and carbon dioxide clearance are considered adequate. We aimed to compare outcomes associated with permissive versus conventional V-V ECMO weaning.Methods We conducted a retrospective single-center cohort study including adult patients with refractory ARDS treated with V-V ECMO between January 2015 and December 2022 who were successfully decannulated while receiving invasive mechanical ventilation. Permissive weaning was defined as ECMO decannulation despite persistence of at least one of the following criteria during the sweep gas-off trial: plateau pressure ≥30 cmH₂O, driving pressure ≥20 cmH₂O, positive end-expiratory pressure ≥15 cmH₂O, or tidal volume ≤5 mL/kg predicted body weight. The primary outcome was 90-day mortality after ECMO decannulation. Secondary outcomes included liberation from mechanical ventilation within 90 days, analyzed using competing-risk models with death as a competing event. Associations with mortality were assessed using landmark Cox proportional hazards models anchored at decannulation.Results Among 469 patients treated with V-V ECMO, 280 successfully decannulated patients were included; 117 (42%) underwent permissive weaning and 163 (58%) conventional weaning. Baseline characteristics were broadly similar, although body mass index was higher and SARS-CoV-2 ARDS more frequent in the permissive group. Patients undergoing permissive weaning had longer ECMO support (19 [9-37] vs. 12 [6-27] days; p < 0.01). At the sweep gas-off trial, respiratory mechanics remained more impaired in the permissive group, whereas oxygenation parameters were comparable. In landmark analysis, permissive weaning was associated with higher 90-day mortality in both univariable (hazard ratio [HR] 3.53, 95% confidence interval [CI] 1.62-7.66; p < 0.01) and multivariable analyses (adjusted HR 4.45, 95% CI 1.98-9.97; p < 0.01). However, permissive weaning was not associated with delayed liberation from mechanical ventilation by day 90 (adjusted subdistribution HR 0.90, 95% CI 0.70-1.17; p = 0.4).Conclusions Among patients with severe ARDS successfully decannulated from V-V ECMO, permissive weaning was associated with increased 90-day mortality but not with delayed liberation from mechanical ventilation.
SN - 2110-5820
ER -