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- Title
Patient-centered weaning from venoarterial extracorporeal membrane oxygenation: "A practice-oriented narrative review of literature".
- Authors
Hermens, Jeannine AJ; Meuwese, Christiaan L; Szymanski, Mariusz K; Gianoli, Monica; van Dijk, Diederik; Donker, Dirk W
- Abstract
Venoarterial extracorporeal membrane oxygenation (V-A ECMO) is increasingly used in cardiogenic shock for rapid stabilization and bridging towards recovery, long-term mechanical circulatory support or transplant. Although technological advances have instigated its widespread use, the complex, long-lasting ECMO care creates a significant strain on hospital staff and resources. Therefore, optimal clinical management including timely decisions on ECMO removal and further therapy are pivotal, yet require a well-structured weaning approach. Although dedicated guidelines are lacking, a variety of weaning protocols have distillated echocardiographic and hemodynamic predictors for successful weaning. Nevertheless, a strikingly high mortality up to 70% after initial successful weaning raises concerns about the validity of current weaning strategies. Here, we plead for a patient-tailored approach including a bailout strategy when weaning fails. This should account not only for left- but also right ventricular function and interdependence, as well as the temporal course of cardiac recovery in function of extracorporeal support. Patients with a high risk of weaning failure should be identified early, enabling timely transportation to an advanced heart failure center. This review summarizes predictors of successful weaning and discusses all relevant elements for a structured weaning approach with a central role for patient-specific clinical considerations and echocardiography.
- Subjects
ECHOCARDIOGRAPHY; LEFT heart ventricle; RIGHT heart ventricle; EXTRACORPOREAL membrane oxygenation; PATIENT-centered care; DOCUMENTATION; VENTILATOR weaning; ALGORITHMS
- Publication
Perfusion, 2023, Vol 38, Issue 7, p1349
- ISSN
0267-6591
- Publication type
Article
- DOI
10.1177/02676591221115938