Real-time Echocardiography-guided Weaning of Veno-arterial Extracorporeal Membrane Oxygenation in Neonates

Objective: The objective of the study is to evaluate the utility of real-time echocardiography (RTE) to provide objective hemodynamic guidance during decannulation of neonates from extracorporeal membrane oxygenation (ECMO). Design: Retrospective case series. Patients: Neonates with respiratory and circulatory failure who underwent venoarterial ECMO (VA-ECMO). Interventions: Use of RTE to assess cardiac function, pulmonary hypertension (PH), and readiness for decannulation from ECMO. Outcome measures: Data abstracted included clinical parameters, RTE data, and management decisions during weaning from VA-ECMO. Results: We used RTE during weaning in 12 of 33 patients between 2016 and 2019. Findings prompted inotrope titration in 10 (83%) patients and volume resuscitation in 10 patients. PH was present in 12 (100%) patients and prompted initiation of prostaglandin infusion (in 3 (25%) patients. Ten of 12 patients were successfully weaned off; in 2, RTE was instrumental in halting decannulation. Conclusions: RTE may serve as a valuable tool in clinical decision-making while weaning neonates from VA-ECMO and providing data to choose appropriate support for successful decannulation. (2022):