Aortic valve opening status best predicts VA-ECMO weaning success in cardiogenic shockHeart ultrasound helps predict success for patients on heart machines

ObjectiveThis study aimed to evaluate the predictive value of critical care echocardiographic parameters for weaning outcomes in patients receiving venoarterial extracorporeal membrane oxygenation (VA-ECMO) for cardiogenic shock.MethodsA comprehensive literature search was conducted across PubMed, Embase, Cochrane Library, Web of Science, Scopus, and CINAHL from inception to December 2025. Studies reporting echocardiographic predictors of VA-ECMO weaning outcomes were included. A two-component analytical approach was applied, which pooled standardized mean differences for association analyses and used bivariate random-effects modeling (Reitsma method) for diagnostic accuracy.ResultsA total of 37 studies encompassing 3,458 patients were analyzed. Aortic valve opening status exhibited the highest discriminative ability (AUC = 0.88, 95% CI: 0.82–0.93), followed by left ventricular outflow tract velocity-time integral (AUC = 0.85, 95% CI: 0.81–0.88), tissue Doppler-derived mitral annular systolic velocity (AUC = 0.81, 95% CI: 0.76–0.86), and left ventricular ejection fraction (AUC = 0.79, 95% CI: 0.75–0.83). Provisional reference thresholds, derived primarily from studies using a 48-h decannulation definition, included LVEF 20–25%, LVOT-VTI ≥ 10 cm, and TAPSE ≥17 mm; these should be interpreted as exploratory rather than confirmatory.ConclusionThis meta-analysis describes a hierarchy of echocardiographic parameters for predicting VA-ECMO weaning success and provides provisional reference thresholds that may inform—but do not replace — individualized clinical judgment in cardiogenic shock management.