A Weaning Protocol for Venovenous Extracorporeal Membrane Oxygenation With a Review of the Literature

Abstract

Several articles have discussed the weaning process for venoarterial extracorporeal membrane oxygenation; however, there is no published report to outline a standardized approach for weaning a patient from venovenous extracorporeal membrane oxygenation (ECMO). This complex process requires an organized approach and a thorough understanding of ventilator management and ECMO physiology. The purpose of this article is to describe the venovenous ECMO weaning protocol used at our institution as well as provide a review of the literature.

The impact of obesity on outcomes in patients receiving extracorporeal life support

“… 11,13,34,35 . Furthermore, patients receiving VV ECLS are generally hemodynamically stable, while VA ECLS is often administered in the setting of profound circulatory failure 11,12,34 . Greater complication rates have been reported for VA support modalities compared to VV, with unique risks including cardiac thrombosis and elevated risk of coronary and cerebral hypoxia 13 .…”

“…Extracorporeal life support (ECLS) is a complex life support modality which has experienced a dramatic increase in utilization over the past decade 1 . It is now used more frequently to manage cardiopulmonary failure, 2 postcardiotomy syndrome, refractory cardiogenic shock, as well as complications of lung and heart transplantation 3‐12 . Technical advances in extracorporeal technology, improved delivery, and greater clinical expertise in its management have made ECLS an invaluable support modality with steadily improving survival.…”

Disseminated Gestational Trophoblastic Disease and Diffuse Alveolar Hemorrhage Treated With Extracorporeal Membrane Oxygenation

“…Treatment outcomes in such late-stage cases may depend highly upon survival through this critical stage [4]. Metastatic GTD involving the lungs with DAH requiring invasive mechanical ventilation with high PEEP is typically unresponsive to traditional rescue therapies [3,5]. In severe circumstances, ECMO has been used as salvage therapy, maintaining acceptable gas exchanges, limiting ventilator-induced lung injury, and providing the necessary time to treat the underlying etiology.…”

“…DAH-related ARDS is associated with severe presentations and a high incidence of complications, especially in pregnant patients [4]. Use of ECMO in DAH has been reported in small case series with favorable outcomes [5,6]. Although no evidence-based literature exists to guide ECMO use in pregnant or post-partum patients with DAH, there is literature addressing ECMO use in such patients with influenza-related ARDS.…”

A Time to Heal: The EMPROVE Protocol

“…Our program developed and implemented an “ultra‐lung protective” strategy named the EMPROVE protocol, or E C M O for PRO tective VE ntilation. This protocol is based upon a contemporary understanding of ventilator‐induced lung injury, as well as our combined clinical experience at multiple institutions . It provides a common language that can be easily communicated between the many disciplines required for the successful outcomes of these patients.…”