Authors (including presenting author) :
Lau FM(1); Chan WK(1); Ng PY(1)(2); Kwok WL (1); Yu KY(1); Sin WC (1)(2); Ngai CW(1); Chan WM(1); Lai CK(1)
Affiliation :
(1)Adult Intensive Care Unit, Queen Mary Hospital; (2)Critical Care Medicine Unit, The University of Hong Kong
Introduction :
The recovery phase of a patient supported by V-A ECMO can be unpredictable. The optimal strategy to wean V-A ECMO support remains controversial. The commonest adopted approaches include decremental flow reduction and arteriovenous bridging recirculation technique. Yet, they are limited by a large variability between institutions and a heightened risk of thromboembolic events respectively. Introduction of Pump Controlled Retrograde Trial Off (PCRTO) permits thorough native heart and lung assessment on patients with V-A ECMO but is not well described in the adult population. We describe the experience in utilizing PCRTO as a routine weaning strategy in an ECMO centre.
Objectives :
(1): Exemplify the feasibility and efficiency of PCRTO in weaning V-A ECMO in the adult population (2): Demonstrate ongoing care and monitoring during PCRTO
Methodology :
We retrospectively reviewed all V-A ECMO patients in a 20-bed adult Intensive Care Unit (ICU) from January 2019 to November 2021. ICU survival, ECMO outcomes and PCRTO endpoints were investigated.
Result & Outcome :
During the study period, 77 patients received peripheral V-A ECMO support. 62 sessions of PCRTO were performed on 39 patients receiving peripheral V-A ECMO support. 69.2% (n=27) of patients receiving PCRTO survived, were weaned from ECMO and subsequently discharged from ICU. 89.7% (n=35) of the patients with PCRTO performed were successfully decannulated. The median duration per session was 180 (120-140) minutes. The median time from ECMO initiation to first PCRTO was 81 (53-121) hours. 19.4% (n=12) of the trials required premature termination due to acute blockage of the endotracheal tube (n=1), suspected end-organs including lower limbs and cerebral hypoperfusion (n=7), and suspected RV failure (n=4). No thromboembolic events have been encountered. Our centre’s experience suggests that PCRTO is a feasible option to assess the readiness to liberate from V-A ECMO support without jeopardizing patient safety. It allows comprehensive assessment of end-organ functions and eliminates the need for ECMO circuit modification.
