Objective:

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.

Approach:

• Literature Search: A comprehensive search was conducted across multiple databases from inception to December 2025 for studies reporting echocardiographic predictors of VA-ECMO weaning outcomes.
• Analytical Methods: A two-component analytical approach was applied, pooling standardized mean differences for association analyses and using bivariate random-effects modeling for diagnostic accuracy.

Key Findings:

• A total of 37 studies encompassing 3,458 patients were analyzed.
• Aortic valve opening status had the highest discriminative ability (AUC = 0.88, 95% CI: 0.82–0.93).
• Left ventricular outflow tract velocity-time integral (AUC = 0.85, 95% CI: 0.81–0.88) and tissue Doppler-derived mitral annular systolic velocity (AUC = 0.81, 95% CI: 0.76–0.86) followed.
• Provisional reference thresholds included LVEF 20–25%, LVOT-VTI ≥ 10 cm, and TAPSE ≥17 mm.

Interpretation:

The meta-analysis identifies a hierarchy of echocardiographic parameters for predicting VA-ECMO weaning success.

Limitations:

• Most studies were retrospective and conducted in single institutions with small sample sizes.
• There is variability in the definition of successful weaning across studies.

Conclusion:

The study provides insights into echocardiographic predictors for VA-ECMO weaning.