Preadmission β-blocker use was significantly associated with a decreased risk for ECMO weaning failure (hazard ratio, 0.61 [95% CI, 0.40-0.91]) in patients with severe cardiogenic shock supported by venoarterial extracorporeal membrane oxygenation.
Preadmission β-blocker use was significantly associated with a decreased risk for ECMO weaning failure in multivariable analysis.
ECMO weaning failure occurred less frequently in the β-blocker group compared with the non-β-blocker group, though the unadjusted difference did not reach statistical significance.
Preadmission β-blocker use was associated with lower inotrope requirements during V-A ECMO support.
No significant difference was observed in the trend of hemodynamic and metabolic parameters during ECMO support between β-blocker and non-β-blocker groups.
The study population consisted of adult patients with severe cardiogenic shock supported by V-A ECMO across multiple centers.
This research suggests that patients who were already taking beta-blocker medications at home before experiencing severe heart failure (cardiogenic shock) had better outcomes when they needed a heart-lung bypass machine called venoarterial extracorporeal membrane oxygenation (V-A ECMO) to keep them alive. Specifically, patients who had taken beta-blockers within 48 hours before being placed on ECMO were about 39% less likely to experience 'weaning failure' — meaning they were more likely to successfully come off the machine without dying, needing to go back on ECMO, or requiring a heart transplant or other heart replacement therapy. Out of 307 patients studied across multiple hospitals, about 46% of beta-blocker users experienced weaning failure compared to about 57% of non-users. The study also found that patients who had been on beta-blockers needed fewer medications to support their heart function (inotropes) while on ECMO, suggesting their hearts may have been in a somewhat more protected or less stressed state. Interestingly, standard measurements of blood flow and metabolic function did not differ significantly between the two groups during ECMO support, meaning the benefit of beta-blockers wasn't obvious from routine monitoring alone. This research suggests that prior beta-blocker use may have a cardioprotective effect even in the most severe cases of heart failure requiring mechanical support. The authors note that future studies are needed to confirm these findings and to explore whether it might be safe and beneficial to continue low doses of beta-blockers during cardiogenic shock treatment — a question that has historically been controversial given that beta-blockers can reduce heart function in the short term.
van Steenwijk M, Uitbeijerse L, Pladet L, van Esch A, Taverne Y, Donker D, et al.. (2026). Association Between Preadmission β-Blocker Use and Venoarterial Extracorporeal Membrane Oxygenation Weaning Failure in Patients With Cardiogenic Shock.. Journal of the American Heart Association. https://doi.org/10.1161/JAHA.125.046530