Vasopressor Requirements after Initiation of Venovenous Extracorporeal Membrane Oxygenation in Patients with Severe Respiratory Failure.

Background: Patients with severe respiratory failure frequently suffer from concomitant haemodynamic compromise. By correcting respiratory acidosis and permitting reduced mechanical ventilation pressures, venovenous extracorporeal membrane oxygenation (V-V ECMO) may indirectly improve haemodynamics. The aim of this study was to assess how vasopressor requirements changed after V-V ECMO cannulation, and which factors were the primary drivers of this change. Methods: This retrospective single-centre study included 107 consecutive adult recipients of V-V ECMO from 2010 to 2024 who required noradrenaline within 24 h before ECMO cannulation. The primary outcome was the change in Vasoactive-Inotropic Score (VIS) from Day 0 (24 h before) to Day 1 (24 h after ECMO initiation). Secondary outcomes included changes in fluid balance, ventilator settings, blood gas and laboratory parameters. A linear mixed-effects model was used to assess the effects of daily net fluid balance, mean airway pressure (P Results: From Day 0 to Day 1, the daily mean VIS significantly decreased from a median of 14 (IQR 6, 30) to a median of 12 (5, 22). This was accompanied by significant reductions in P Conclusions: After initiation of V-V ECMO, a significant decrease in vasopressor requirements was observed, this benefit being directly attributable to the correction of severe respiratory acidosis.