Weaning process from venoarterial ECMO

Abstract

There is no consensus among ECMO centers regarding the way to manage weaning from VA-ECMO. Decrease in doses of catecholamine infusion, recovery of a pulse arterial pressure, and improvement of myocardial function assessed with echocardiography are indicating that the patient might be weaned from ECMO. A weaning test has then to be conducted. The only published test at this time consists in a daily transient decrease in ECMO blood flow at 1 L/min during 15 min. Hemodynamic stability and echocardiography parameters, aortic velocity time integral (reflecting cardiac output)>12 cm, left ventricular ejection fraction>20%, and S’ wave at mitral annulus >6 cm/s are predictive of weaning success under this regimen. ECMO explantation is then performed at the patient’s bedside or in the operating room depending on local practice.