Veno-Venous ECMO - Options for Weaning Approach

Background: Veno-venous extracorporeal membrane oxygenation (VV ECMO) is a rescue treatment for the most severe cases of respiratory failure. The preferred approach to weaning patients from VV ECMO is still unknown.

Is a beginning of weaning from a ventilatory machine and then from VV ECMO is a preferable approach to a reverse course with the disconnection from VV ECMO as long as the patient is still connected to the ventilatory machine?

Objectives: To assess the effectiveness and benefits versus the risks arising from different approaches to weaning from VV ECMO.

Methods: The VV ECMO database of Rambam Medical Center, which includes 7 patients between 03/17-10/18 was used. The course of hospitalization, Clinical, complication data of the two patients with a VV ECMO who were first weaned from the ventilatory machine when the patients are still connected to the VV ECMO (group I) were compared to five patients who underwent a reverse process first weaned from ECMO system and then weaning from a ventilatory machine (group II).

Results: The average hospitalization days in group I was 22.5 days compared with 33.6 days in group II, ECMO days connection 8 days compared with 17 days respectively. There no complication at all in group I compared to 60% with ventilatory associated pneumonia (VAP), 40% lung atelectasIs, and 40% pulmonary hemorrhage. 2/5 patients in the second group (40%) underwent tracheostomy and required Longer-term sedation therapy.

Conclusions: Patients from group II who first underwent a disconnection from VV ECMO while they`re still connected to the ventilatory machine have a significantly higher percentage of pulmonary complications with the consequences of prolonged hospitalization and sedative medication usage. Encouraging earlier weaning from MV allowing to avoid the risk of VILI and VAP. Further investigations are necessary in order to standardize the weaning process from VV ECMO.