Early trajectories of pulmonary hemodynamics in acute respiratory distress syndrome (ARDS) patients undergoing V-V ECMO: key determinants and prognostic impact
Authors' conclusion
Pulmonary hypertension is highly prevalent in ARDS patients on V-V ECMO and reflects underlying disease severity. Early upward trajectories in mPAP, rather than the initial mPAP value, independently predicted higher mortality.
Study context
- Population
- Adults with ARDS receiving V–V ECMO monitored with a pulmonary artery catheter, tertiary referral center, 2003–2024of 240 consecutive
- Participants
- 225 adults
- Outcome
- Determinants of mPAP; association of day-1 mPAP and mPAP trajectory over first 5 ECMO days (patient-specific daily slope) with hospital mortality
Methodological detailssingle-centre, tertiary referral center, linear mixed-effects model, logistic regression with adjustment for confounders, Daily hemodynamic, ventilatory and gas exchange data prospectively collected
- Single-centre
- Tertiary referral center
- Linear mixed-effects model
- Logistic regression with adjustment for confounders
- Daily hemodynamic, ventilatory and gas exchange data prospectively collected
Main finding
As reported in the abstract
mPAP during ECMO and its association with hospital mortality
Median mean pulmonary artery pressure (mPAP) during ECMO (mmHg) [IQR]
27
23–32
Measurements exceeding 20 mmHg
91%
mPAP trajectory over first 5 days independently associated with mortality, adjusted OR per 1-mmHg/day increase
1.89
95% CI 1.33–2.77p < 0.001
Observational data: associations, not effects.
Original publication
Early trajectories of pulmonary hemodynamics in ARDS patients undergoing V-V ECMO: key determinants and prognostic impact. Crit Care. Published 2 March 2026. doi:10.
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