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Article: Feasibility of pump‐controlled retrograde trial off in weaning from veno‐arterial ECMO in adults: A single‐center case series

TitleFeasibility of pump‐controlled retrograde trial off in weaning from veno‐arterial ECMO in adults: A single‐center case series
Authors
KeywordsECMO
PCRTO
retrograde
veno-arterial ECMO
weaning
Issue Date3-Apr-2023
PublisherWiley
Citation
Artificial Organs, 2023, v. 47, n. 6, p. 1046-1058 How to Cite?
Abstract

Background

Various strategies of weaning V-A ECMO have been described. PCRTO is a weaning technique which involves serial decremental pump revolutions until a retrograde flow from the arterial to venous ECMO cannula is achieved. It has been reported as a feasible weaning strategy in the pediatric population, but its application in adults has not been widely reported.

Methods

This was a case series including all adult patients who underwent PCRTO during weaning from V-A ECMO at a tertiary ECMO center between January 2019 and July 2021. The primary end point was the successful weaning from V-A ECMO support.

Results

A total of 57 runs of PCRTO in 36 patients were analyzed—45 (78.9%) of the trials were concluded successfully. The median retrograde blood flow rate during PCRTO was 0.6 ± 0.2 L/min, and the median duration of each PCRTO was 180 (120–240) min. Of the 35 patients who had at least one session of successful PCRTO, 31 (88.6%) were ultimately weaned from ECMO. There were no major complications from PCRTO including systemic or circuit thrombosis.

Conclusions

PCRTO is a feasible strategy for assessing readiness for weaning from V-A ECMO with a low risk of adverse events and high rate of predicting eventual successful ECMO decannulation. Further investigation including comparison with alternative weaning strategies in prospective studies is required to confirm the approach.


Persistent Identifierhttp://hdl.handle.net/10722/331025
ISSN
2023 Impact Factor: 2.2
2023 SCImago Journal Rankings: 0.651
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorLau, FM-
dc.contributor.authorChan, WK-
dc.contributor.authorMok, YT-
dc.contributor.authorLai, PCK-
dc.contributor.authorMa, SKT-
dc.contributor.authorNgai, CW-
dc.contributor.authorSin, WC-
dc.contributor.authorKwok, WLP-
dc.contributor.authorYu, KY-
dc.contributor.authorChan, WM-
dc.contributor.authorFraser, JF-
dc.contributor.authorNg, PY-
dc.date.accessioned2023-09-21T06:52:06Z-
dc.date.available2023-09-21T06:52:06Z-
dc.date.issued2023-04-03-
dc.identifier.citationArtificial Organs, 2023, v. 47, n. 6, p. 1046-1058-
dc.identifier.issn0160-564X-
dc.identifier.urihttp://hdl.handle.net/10722/331025-
dc.description.abstract<h3>Background</h3><p>Various strategies of weaning V-A ECMO have been described. PCRTO is a weaning technique which involves serial decremental pump revolutions until a retrograde flow from the arterial to venous ECMO cannula is achieved. It has been reported as a feasible weaning strategy in the pediatric population, but its application in adults has not been widely reported.</p><h3>Methods</h3><p>This was a case series including all adult patients who underwent PCRTO during weaning from V-A ECMO at a tertiary ECMO center between January 2019 and July 2021. The primary end point was the successful weaning from V-A ECMO support.</p><h3>Results</h3><p>A total of 57 runs of PCRTO in 36 patients were analyzed—45 (78.9%) of the trials were concluded successfully. The median retrograde blood flow rate during PCRTO was 0.6 ± 0.2 L/min, and the median duration of each PCRTO was 180 (120–240) min. Of the 35 patients who had at least one session of successful PCRTO, 31 (88.6%) were ultimately weaned from ECMO. There were no major complications from PCRTO including systemic or circuit thrombosis.</p><h3>Conclusions</h3><p>PCRTO is a feasible strategy for assessing readiness for weaning from V-A ECMO with a low risk of adverse events and high rate of predicting eventual successful ECMO decannulation. Further investigation including comparison with alternative weaning strategies in prospective studies is required to confirm the approach.</p>-
dc.languageeng-
dc.publisherWiley-
dc.relation.ispartofArtificial Organs-
dc.rightsThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.-
dc.subjectECMO-
dc.subjectPCRTO-
dc.subjectretrograde-
dc.subjectveno-arterial ECMO-
dc.subjectweaning-
dc.titleFeasibility of pump‐controlled retrograde trial off in weaning from veno‐arterial ECMO in adults: A single‐center case series-
dc.typeArticle-
dc.identifier.doi10.1111/aor.14527-
dc.identifier.scopuseid_2-s2.0-85152088323-
dc.identifier.volume47-
dc.identifier.issue6-
dc.identifier.spage1046-
dc.identifier.epage1058-
dc.identifier.eissn1525-1594-
dc.identifier.isiWOS:000962518500001-
dc.identifier.issnl0160-564X-

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