Sex Differences in Vasopressor De-escalation With Arginine Vasopressin in Mixed Cardiogenic-Vasodilatory Shock Under VA-ECMO
Main finding · Successful vasopressor de-escalation (NEE <0.25 µg/kg/min)Result — go to the resultAOR for treatment success 2.08 95% CI 1.07–4.15Authors' conclusion
Female sex, particularly in a postmenopausal context, was independently associated with impaired vasopressor de-escalation following AVP in CS on VA-ECMO. These hypothesis-generating findings suggest that hormonal status may modulate vascular responsiveness to AVP and support the need for prospective studies incorporating hormonal profiling.
Study context
- Population
- VA-ECMO-supported cardiogenic shock (CS) patients given arginine vasopressin (AVP)
- Participants
- 193 eligible patients
- Exposure
- Sex differences in treatment response and NEE trajectories after AVP initiation
- Outcome
- Successful vasopressor de-escalation (NEE <0.25 µg/kg/min)
- Follow-up
- 48 hours
Methodological detailsmultivariable logistic regression, linear mixed-effects models
- Multivariable logistic regression
- Linear mixed-effects models
Main finding
As reported in the abstract
AOR for treatment success
2.08
95% CI 1.07–4.15
P = 0.033
By group
Men vs Women
aOR for treatment success 2.08 (95% CI 1.07–4.15); P = 0.033
Observational data: associations, not effects.
Further findings
Excess failure risk, postmenopausal women aged ≥55 years (subgroup)
| aOR for failure (95% CI) | P value | ||
|---|---|---|---|
| Postmenopausal women aged ≥55 yearsComparator not stated | 2.75 (1.32–5.93) | P = 0.008 | |
| 0.20.5125AOR for failure (log scale) |
NEE trajectories · 48 hours
- NEE at 48 hours (divergence), p = 0.008
- 0.24 vs. 0.01 µg/kg/min
- Significant sex-by-time interaction (p = 0.041); divergence emerged at 48 hours (NEE 0.24 vs. 0.01 µg/kg/min, p = 0.008)
Excess failure risk, postmenopausal women aged ≥55 years (subgroup)
- Excess failure risk confined to postmenopausal women aged ≥55 years
Original publication
Sex Differences in Vasopressor De-escalation With Arginine Vasopressin in Mixed Cardiogenic-Vasodilatory Shock Under VA-ECMO. Anaesth Crit Care Pain Med. Published 13 October 2026. doi:10.
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