Pump-controlled retrograde trial off extracorporeal membrane oxygenation.

Abstract

Venoarterial extracorporeal membrane oxygenation weaning strategies are not standardized. When dealing with patients with complex physiologies and borderline haemodynamics, it is prudent to have a fail-safe method of approaching decannulation from extracorporeal membrane oxygenation. Standardizing the extracorporeal membrane oxygenation weaning strategy with a pump-controlled retrograde trial off protocol seems a feasible alternative to traditional venoarterial extracorporeal membrane oxygenation weaning approaches. We advocate that having a pump-controlled retrograde trial off protocol for weaning could be done consistently, reliably and validly to assess a patient's ability to be weaned off extracorporeal membrane oxygenation successfully. The advantages of a pump-controlled retrograde trial off versus traditional weaning strategies are threefold: (i) It allows one to do a stress test on the cardiorespiratory reserve of the patient with borderline haemodynamics while having the extracorporeal membrane oxygenation circuit as a fail-safe protection. (ii) It can be standardized and consistently performed regardless of the operator. (3) It allows multiple attempts at weaning without sacrificing the extracorporeal membrane oxygenation circuit by a reduction in risk of circuit clotting. We present the step-by-step approach for conducting a pump-controlled retrograde trial off protocol with video in a neonate with myocarditis, with improving but borderline myocardial function and moderate to severe mitral regurgitation. The pump-controlled retrograde trial off was able to predict successful separation from extracorporeal membrane oxygenation, and the patient was subsequently decannulated successfully.