Weaning from ECMO: Decannulation:
V-V ECMO
When a patient is ready, the ECMO cannulas need to be removed. At TGH this is performed by the lung transplant surgical service. In general:
- Heparin should be switched off 30-60 minutes prior to decannulation.
- The VV lines are removed at the bedside under local anesthesia.
- Pursestring sutures are placed by the surgical team, and the lines are withdrawn sequentially.
- Pressure is placed on the site until bleeding stops.
- When removing a venous cannula in a spontaneously breathing patient, there is a risk of entraining air through the sideholes, so a valsalva maneuver can be employed to prevent this.
Discontinuing ECMO for Futility
Unfortunately some patients who are started on ECMO are unable to regain cardiac or pulmonary function, despite medical and/or surgical therapy. Other patients may have a non-survivable injury while on ECMO. In these cases, it may be necessary to discontinue ECMO, knowing the patient will be unable to survive.
The decision to discontinue ECMO is evaluated on a case by case bases, and requires multidisciplinary input. However some of these criteria may suggest that a patient will have a minimal chance for a healthy recovery from ECMO:
- Minimal cardiac function after 3 days on V-A ECMO, and no eligibility for transplant or VAD.
- Minimal lung function after 2 weeks on V-V ECMO.
- Devastating neurologic injury.
- Refractory multi-organ failure.
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