{"title":"Redefining weaning in a VA ECMO: a case report on pump-controlled retrograde trial off.","authors":"Raghavendra Deshpande, Rajavardhan Rangappa, Saikat Kanjilal, Narayana Swamy Moola, Suriyanathan Madhan Kumar","doi":"10.1007/s12055-025-01895-x","DOIUrl":null,"url":null,"abstract":"<p><p>Extracorporeal membrane oxygenation (ECMO) is widely recognized as a life-saving measure. The use of veno-arterial extracorporeal membrane oxygenation (VA ECMO) is on the rise, serving as an effective mechanical circulatory support (MCS) device that aids in the restoration of systemic perfusion in patients suffering from cardiogenic shock. Weaning methods for VA ECMO exhibit considerable variability, with pump-controlled retrograde trial off (PCRTO) being one of the methods employed. PCRTO is a practical weaning method due to its physiological approach. In this case report, we discuss the application of PCRTO, in conjunction with a pulmonary artery catheter, for weaning a 41-year-old male patient from VA ECMO. The patient presented with acute coronary syndrome with cardiogenic shock. PCRTO played a pivotal role in the successful explantation of the ECMO cannulae, particularly given the patient's uncertain cardiorespiratory recovery. The PCRTO method, being both feasible and reversible, serves as a significant predictor for successful weaning from VA ECMO through a preload stress test. This case underscores the potential of PCRTO as a valuable tool in the weaning process from VA ECMO.</p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s12055-025-01895-x.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 7","pages":"937-941"},"PeriodicalIF":0.7000,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12170960/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Indian Journal of Thoracic and Cardiovascular Surgery","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1007/s12055-025-01895-x","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/2/1 0:00:00","PubModel":"Epub","JCR":"Q4","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
Abstract
Extracorporeal membrane oxygenation (ECMO) is widely recognized as a life-saving measure. The use of veno-arterial extracorporeal membrane oxygenation (VA ECMO) is on the rise, serving as an effective mechanical circulatory support (MCS) device that aids in the restoration of systemic perfusion in patients suffering from cardiogenic shock. Weaning methods for VA ECMO exhibit considerable variability, with pump-controlled retrograde trial off (PCRTO) being one of the methods employed. PCRTO is a practical weaning method due to its physiological approach. In this case report, we discuss the application of PCRTO, in conjunction with a pulmonary artery catheter, for weaning a 41-year-old male patient from VA ECMO. The patient presented with acute coronary syndrome with cardiogenic shock. PCRTO played a pivotal role in the successful explantation of the ECMO cannulae, particularly given the patient's uncertain cardiorespiratory recovery. The PCRTO method, being both feasible and reversible, serves as a significant predictor for successful weaning from VA ECMO through a preload stress test. This case underscores the potential of PCRTO as a valuable tool in the weaning process from VA ECMO.
Supplementary information: The online version contains supplementary material available at 10.1007/s12055-025-01895-x.
期刊介绍：
The primary aim of the Indian Journal of Thoracic and Cardiovascular Surgery is education. The journal aims to dissipate current clinical practices and developments in the area of cardiovascular and thoracic surgery. This includes information on cardiovascular epidemiology, aetiopathogenesis, clinical manifestation etc. The journal accepts manuscripts from cardiovascular anaesthesia, cardiothoracic and vascular nursing and technology development and new/innovative products.The journal is the official publication of the Indian Association of Cardiovascular and Thoracic Surgeons which has a membership of over 1000 at present.DescriptionThe journal is the official organ of the Indian Association of Cardiovascular-Thoracic Surgeons. It was started in 1982 by Dr. Solomon Victor and ws being published twice a year up to 1996. From 2000 the editorial office moved to Delhi. From 2001 the journal was extended to quarterly and subsequently four issues annually have been printed out at time and regularly without fail. The journal receives manuscripts from members and non-members and cardiovascular surgeons. The manuscripts are peer reviewed by at least two or sometimes three or four reviewers who are on the panel. The manuscript process is now completely online. Funding the journal comes partially from the organization and from revenue generated by subscription and advertisement.
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