Usefulness of classical systemic inflammatory response syndrome (SIRS) criteria after VA-ECMO withdrawal

The use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) as mechanical circulatory support is increasingly common in patients with cardiogenic shock. Decannulation remains a clinical challenge and, in some cases, may trigger a systemic inflammatory response whose pathophysiological mechanism and prognostic significance are still unclear. This study aimed to assess whether the classical parameters defining systemic inflammatory response syndrome (SIRS) have clinical and/or prognostic value in this setting.

We conducted a retrospective observational study based on a prospective cohort of patients who underwent emergent peripheral VA-ECMO implantation between 2020 and 2025. Only those who were successfully weaned from ECMO were included, excluding patients who died within the first 48 hours after withdrawal. The presence of SIRS criteria was assessed during the first 48 hours post-decannulation.

A total of 38 patients were analyzed, with a median age of 59.1 years, and 68.4% were male.

Regarding individual SIRS criteria: 31.6% of patients had a heart rate ≥90 bpm within the first 48 hours, 5.3% had pCO₂ <32 mmHg, 44.7% reached a temperature ≥37.5°C, and 47.4% presented leukocytosis >12,000/mm³ and/or leukopenia <4,000/mm³. Overall, 21 patients (55.3%) met at least two criteria and were therefore classified as having SIRS.

The presence of SIRS was not associated with a higher incidence of post-decannulation infection. Although 33.3% of SIRS patients required higher vasopressor support, differences were not statistically significant compared with the non-SIRS group. Overall survival was 73.7%, with no significant differences between groups, including neurological outcomes at discharge (Figure 1).

In this study, classical SIRS criteria following VA-ECMO decannulation did not identify a subgroup of patients at higher risk of developing infection or with increased mortality. Fever and leukocytosis were frequent findings but did not translate into hemodynamic instability or worse prognosis.