Early experience of pump-controlled retrograde trial off for weaning from veno-arterial extracorporeal membrane oxygenation in adult patients with cardiogenic shock

Abstract

Introduction: Pump-controlled retrograde trial off has recently been introduced as an effective method for weaning from veno-arterial extracorporeal membrane oxygenation in pediatric patients. However, studies on pump-controlled retrograde trial off in adults are still lacking. Thus, this study aimed to examine the outcomes of pump-controlled retrograde trial off for weaning from veno-arterial extracorporeal membrane oxygenation in adult patients. Methods: Between January 2018 and July 2019, 87 consecutive adult patients underwent veno-arterial extracorporeal membrane oxygenation support, of whom 47 (54.0%) underwent pump-controlled retrograde trial off for weaning from extracorporeal membrane oxygenation and were enrolled in this study. The pump-controlled retrograde trial off results, extracorporeal membrane oxygenation reapplication rate, and clinical outcomes were analyzed. Results: Of the 47 patients, 38 (80.9%) were weaned from veno-arterial extracorporeal membrane oxygenation on the first attempt of pump-controlled retrograde trial off, 5 (10.6%) on the second attempt, and 4 (8.5%) on the third attempt. Three patients were converted to venovenous extracorporeal membrane oxygenation by desaturation but had stable blood pressure during pump-controlled retrograde trial off. No extracorporeal membrane oxygenation reapplication was performed within 3 days after removal, and two patients underwent veno-arterial extracorporeal membrane oxygenation during follow-up. No complications associated with pump-controlled retrograde trial off occurred during the weaning process, including thromboembolic events. Five in-hospital deaths (10.6%) occurred after weaning from extracorporeal membrane oxygenation. Conclusion: Pump-controlled retrograde trial off is an effective method to safely wean from veno-arterial extracorporeal membrane oxygenation in adult patients. It is simple and can be easily implemented without additional invasive procedures and may help prevent deterioration of the cardiovascular system after weaning from veno-arterial extracorporeal membrane oxygenation.

How to Do Weaning and Decannulation in Adult Cardiac

“…Patients can be considered ready for decannulation if the hemodynamic and echocardiographic criteria are met after a few minutes or hours [8]. Some researchers reported PCRTO to be a safe, simple, and reproducible approach for enabling a trial period while preserving the circuit during weaning from VA ECMO [9,10]. In stable patients, PCRTO seems reasonable even if it is tested for 5-10 minutes without additional heparin or decannulation.…”

Pump-controlled retrograde trial off for weaning from adult veno-arterial extracorporeal membrane oxygenation – a retrospective observation cohort

“…A novel weaning strategy, pump-controlled retrograde trial off (PCRTO), has emerged as a potential remedy to the captioned problems 13 . PCRTO can be e ciently executed by turning down the pump head revolutions until blood ows in a "retrograde" manner from the arterial cannula through the ECMO circuit and returning to the venous cannula without requiring any modi cation of the existing circuit [12][13][14] . The ability of the left heart to generate su cient cardiac output for systemic oxygen delivery, as well as the tolerance of the right heart to near-normal venous return, can be tested simultaneously during PCRTO.…”

“…If hemodynamic instability is encountered during the trial, full ECMO support can be resumed instantaneously by increasing the pump head revolutions and restoring veno-arterial ow. PCRTO was originally reported in the pediatric population 12 , its use has not been more broadly adopted in the adult population in part due to a scarcity of published data and lack of standardized procedures [13][14][15] .…”

Pump‐controlled retrograde trial off for weaning from venoarterial extracorporeal membrane oxygenation in an adult patient with pulmonary embolism

“… 2 As this creates a partial arteriovenous shunt without invasive procedures, PCRTO can simulate weaning off ECMO by providing adequate preload to assess accurate cardiac function. 3 However, no case reports on PCRTO use in pulmonary embolism (PE) exist. We describe a case of a massive acute pulmonary thromboembolism treated with VA‐ECMO.…”