ArticleFrontiers in medicine2026
Optimization of norepinephrine dosage for hemodynamic stability during ECMO support in refractory shock: a retrospective study.
Article in Frontiers in medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) serves as a crucial salvage therapy for refractory shock; however, the optimal strategy for vasopressor management during extracorporeal circulatory support remains unclear. Norepinephrine is a cornerstone agent for maintaining perfusion pressure, yet the association between its dose intensity and patient outcomes remains controversial. Objective: This study aimed to investigate the association between the norepinephrine-equivalent dose during the initial phase of VA-ECMO support and clinical outcomes in patients with refractory shock. Methods: In this retrospective cohort study, 135 patients with refractory shock supported by VA-ECMO in the intensive care unit (ICU) of our hospital from January 2020 to January 2025 were included. Patients were divided into a low-dose group ( Results: At baseline, the high-dose group had significantly higher SOFA scores ( Conclusion: Among patients with refractory shock supported by VA-ECMO, a higher norepinephrine-equivalent dose during the initial support period is independently associated with an increased risk of death and worse clinical outcomes. This suggests the need for careful evaluation and optimization of vasopressor intensity, even when ECMO provides circulatory support.
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