Weaning Strategy from Veno-Arterial Extracorporeal Membrane Oxygenation (ECMO)

Background: Significant advances in extracorporeal technology have led to the more widespread use of veno-arterial extracorporeal membrane oxygenation (VA ECMO) for cardiac failure. However, procedures for weaning from VA ECMO are not standar‐ dized. High death rate after successful weaning shows that many questions remain unresolved in this field. Objectives: In this review, we discuss data from the literature and propose a strategy to optimize the weaning process. Data synthesis and conclusions: It is especially important that the VA ECMO is not removed while the patient is still recovering from the condition that necessitated the use of VA ECMO implantation. Damaged organs need to recover before attempting weaning and the patient should be considered hemodynamically stable. The etiology of cardio-circulatory dysfunction must be compatible with myocardial recovery. Finally, weaning trials using echocardiographic and hemodynamic assessments are indispensable to assess the behavior of the ventricles and to determine whether the VA ECMO can be removed.