Update on the management and associated challenges of adult patients treated with veno-arterial extracorporeal membrane oxygenation

ABSTRACT

Introduction: Currently, veno-arterial extracorporeal membrane oxygenation (VA ECMO) represents a valuable treatment option for patients presenting with severe cardiogenic shock. Although the overall usage of VA ECMO in experienced centers is expanding, some management aspects remain challenging, with no consensus among centers on well-defined assessment criteria, duration, and, particularly, weaning strategies.

Area covered: This article aims to provide a review and evaluation of strategies reported in the literature to wean patients from VA ECMO, with a special emphasis on weaning protocols. A selected successful weaning protocol and rate of removal of adult patients from VA ECMO from recent reports will be also discussed.

Expert commentary: To improve patient outcome, it is essential to remove patients from VA ECMO without weaning failure. Furthermore, the accurate evaluation of the patient’s condition must be principal. However, as technology advances, the strategy of weaning patients from VA ECMO or drug therapies is changing, and we must periodically update our knowledge and use of VA ECMO.

KEYWORDS:

• Heart failure
• mechanical circulatory support
• extracorporeal membrane oxygenation

Article highlights

• ELSO provides the guideline for weaning patients from VA ECMO. However, it is unspecific and requires additional indication.

• Many hospitals adopt guidelines to quantify patient characteristics. Because the patient demographics differ in each hospital, the management approach must have a wide variety of options. Reviewing and incorporating reports provides an extra level of safety for patients after the course of VA ECMO.

• The SRR was found to be approximately 50 to 80%. Most reports showed the order of their weaning protocols as CRITERIA, TRIAL/WEANING, ASSESSMENT and REMOVAL.

• In the CRITERIA and ASSESSMENT steps, specific values including hemodynamic parameters or echocardiographic values were used to evaluate the patients’ status during support with VA ECMO. Some of these values are related to their prognosis.

• Not to miss the opportunity to remove VA ECMO without any weaning failure is thought to be important for their outcome.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.