Top

Indian Journal of Thoracic and Cardiovascular Surgery

Published in:

04-02-2023 | ECMO | Review Article

Discontinuation of ECMO—a review with a note on Indian scenario

Authors: Arpan Chakraborty, Hirak Subhra Majumdar, Writuparna Das, Dipanjan Chatterjee, Kunal Sarkar

Published in: Indian Journal of Thoracic and Cardiovascular Surgery | Special Issue 1/2023

Abstract

Extracorporeal membrane oxygenation (ECMO) has strikingly progressed over the last 20 years in the management of adult and pediatric severe respiratory and cardiac dysfunctions refractory to conventional management. In this review, we will discuss the weaning strategies of veno-venous and veno-arterial ECMO including the bridge to recovery and bridge to transplant along with post-ECMO care. We will also discuss the futility and the management of bridge to nowhere from Indian perspectives.

Rabie AA, Azzam MH, Al-Fares AA, et al. Implementation of new ECMO centers during the COVID-19 pandemic: experience and results from the Middle East and India. Intensive Care Med. 2021;47:887–95. https://doi.org/10.1007/s00134-021-06451-w.CrossRefPubMedPubMedCentral

Al-Fares AA, Ferguson ND, Ma J, et al. Achieving safe liberation during weaning from VV-ECMO in patients with severe ARDS: the role of tidal volume and inspiratory effort. Chest. 2021;160:1704–13. https://doi.org/10.1016/j.chest.2021.05.068.CrossRefPubMed

Enciso JS, Hong KN. ECMO weaning strategies to optimize outcomes. In: Firstenberg MS, editor. Advances in extracorporeal membrane oxygenation - volume 3 [Internet]. London: IntechOpen; 2019 [cited 2022 Apr 09]. Available from: https://www.intechopen.com/chapters/66576https://doi.org/10.5772/intechopen.85614.

Lüsebrink E, Stremmel C, Stark K, et al. Update on weaning from veno-arterial extracorporeal membrane oxygenation. J Clin Med. 2020;9:992. https://doi.org/10.3390/jcm9040992.CrossRefPubMedPubMedCentral

Brodie D, Abrams D, MacLaren G, et al. ECMO during respiratory pandemics: past, present, and future. Am J Respir Crit Care Med. 2022 Feb 25. https://doi.org/10.1164/rccm.202111-2661CP.

Malfertheiner MV, Broman LM, Belliato M, et al. Management strategies in venovenous extracorporeal membrane oxygenation: a retrospective comparison from five European centres. Crit Care Resusc. 2017;19:76–81.PubMed

Broman LM, Malfertheiner MV, Montisci A, Pappalardo F. Weaning from veno-venous extracorporeal membrane oxygenation: how I do it. J Thorac Dis. 2018;10:S692–7.CrossRefPubMedPubMedCentral

Extracorporeal Life Support Organization (ELSO) Guidelines for Adult Respiratory Failure August, 2017

Shekar K, Buscher H, Brodie D. Protocol-driven daily optimisation of venovenous extracorporeal membrane oxygenation blood flows: an alternate paradigm? J Thorac Dis. 2020;12:6854–60. https://doi.org/10.21037/jtd-20-1515.CrossRefPubMedPubMedCentral

10.

Goyal V, Oza P. Weaning and trial off. In: Goyal V, Oza P, editor. ECMO theoretical manual volume II;1^st ed. Mumbai:2012; p. 227 to 229.

11.

Extra corporeal life support Organization. ELSO guidelines for cardiopulmonary extracorporeal life support. Version 1.4. August 2017. Ann Arbor, MI. https://www.elso.org.

12.

Grant AA, Hart VJ, Lineen EB, et al. A weaning protocol for veno-venous extracorporeal membrane oxygenation with a review of literature. Artif Organs. 2018;42:605–10.CrossRefPubMed

13.

Yeo HJ, Kim YS, Kim D, ELSO Registry Committee, Cho WH. Risk factors for complete recovery of adults after weaning from veno-venous extracorporeal membrane oxygenation for severe acute respiratory failure: an analysis from adult patients in the Extracorporeal Life Support Organization registry. J Intensive Care. 2020;8:64. https://doi.org/10.1186/s40560-020-00480-1.CrossRefPubMedPubMedCentral

14.

Vasques F, Romitti F, Gattinoni L, Camporota L. How I wean patients from veno-venous extra-corporeal membrane oxygenation. Crit Care. 2019;23:316.CrossRefPubMedPubMedCentral

15.

Thangappan K, Cavarocchi NC, Baram M, Thoma B, Hirose H. Systemic inflammatory response syndrome (SIRS) after extracorporeal membrane oxygenation (ECMO): incidence, risks, survivals. Heart Lung. 2016;45:449–53.CrossRefPubMed

16.

Aissaoui N, Luyt C-E, Leprince P, et al. predictors of successful extracorporeal membrane oxygenation (ECMO) weaning after assistance for refractory cardiogenic shock. Intensive Care Med. 2011;37:1738–45.CrossRefPubMed

17.

Chakraborty A, Chatterjee D, Sarkar K. Weaning and liberation from V-A ECMO. In: Maybauer MO, editor. Extracorporeal Membrane Oxygenation, An Interdisciplinary Problem-Based Learning Approach. 1st ed. New York: Oxford; 2022. p. 551–2.

18.

Pappalardo F, Pieri M, Arnaez Corada B, et al. Timing and strategy for weaning from venoarterial ECMO are complex issues. J CardiothoracVascAnesth. 2015;29:906–11.

19.

Aissaoui N, El-Banayosy A, Combes A. How to wean a patient from veno-arterial extracorporeal membrane oxygenation. Intensive Care Med. 2015;41:902–5.CrossRefPubMed

20.

Baud FJ, Megarbane B, Deye N, Leprince P. Clinical review: aggressive management and extracorporeal support for drug induced cardiotoxicity. Crit Care. 2007;11:207.CrossRefPubMedPubMedCentral

21.

Durinka JB, Bojar LJ, Hirose H, et al. End-organ recovery is key to success for extracorporeal membrane oxygenation as a bridge to implantable left ventricular assist device. ASAIO J. 2014;60:189-192.CrossRefPubMed

22.

Abrams D, Garan AR, AbdelbaryA, et al. Position paper for the organization of ECMO programs for cardiac failiure in adults. Intensive Care Med. 2018;44:717–29.CrossRefPubMed

23.

Huang K-C, Lin L-Y, Chen Y-S, Lai C-H, Hwang J-J, Lin L-C. Threedimensional echocardiography-derived right ventricular ejection fraction correlates with success of decannulation and prognosis in patients stabilized by venoarterial extracorporeal life support. J Am Soc Echocardiogr. 2018;31:169–79.CrossRefPubMed

24.

Rousse N, Juthier F, Pincon C, et al. ECMO as a bridge to decision: recovery, VAD, or heart transplantation? Int J Cardiol. 2015;187:620–7.CrossRefPubMed

25.

Extracorporeal Life Support Organization. ELSO guidelines for cardiopulmonary extracorporeal life support. Version 1.3. Ann Arbor, MI. November 2013. http://www.elsonet.org.

26.

Loforte A, Marinelli G, Musumeci F, et al. Extracorporeal membrane oxygenation support in refractory cardiogenic shock: treatment strategies and analysis of risk factors. Artif Organs. 2014;38:E129–41.CrossRefPubMed

27.

Li C-L, Wang H, Jia M, Ma N, Meng X, Nou X-T. The early dynamic behaviour of lactate is linked to mortality in post cardiotomy patients with extracorporeal membrane oxygenation support: a retrospective observational study. J Thorac Cardiovasc Surg. 2015;149:1445–50.CrossRefPubMed

28.

Platts DG, Sedgwick JF, Burstow DJ, Mullany DV, Fraser JF. The role of echocardiography in the management of patients supported by extracorporeal membrane oxygenation. J Am Soc Echocardiogr. 2012;25:131–41.CrossRefPubMed

29.

Aissaoui N, Guerot E, Combes A, et al. Two-dimensional strain rate and Doppler tissue myocardial velocities: analysis by echocardiography of hemodynamic and functional changes of the failed left ventricle during different degrees of extracorporeal life support. J Am Soc Echocardiogr. 2012;25:632–40.CrossRefPubMed

30.

Aissaoui N, Brehm C, El-Banayosy A, Alain Combes A. Weaning strategy from veno-arterial extracorporeal membrane oxygenation (ECMO). In: Firstenberg, M. S., editor. Extracorporeal Membrane Oxygenation - Advances in Therapy [Internet]. London: IntechOpen; 2016 [cited 2022 Apr 04]. Available from: https://www.intechopen.com/chapters/51568https://doi.org/10.5772/64013.

31.

Kim D, Park Y, Choi KH, et al. Prognostic implication of RV coupling to pulmonary circulation for successful weaning from extracorporeal membrane oxygenation. JACC Cardiovasc Imaging. 2021;14:1523–31.CrossRef

32.

Ortuno S, Delmas C, Diehl JL, et al. Weaning from veno-arterial extra-corporeal membrane oxygenation: which strategy to use? Ann Cardiothorac Surg. 2019;8:E1–8. https://doi.org/10.21037/acs.2018.08.05.CrossRefPubMedPubMedCentral

33.

34.

Cavarocchi NC, Pitcher HT, Yang Q, et al. Weaning of extracorporeal membrane oxygenation using continuous hemodynamic transesophageal echocardiography. J Thorac Cardiovasc Surg. 2013;146:1474–9.CrossRefPubMed

35.

Affronti A, di Bella I, Carino D, Ragni T. Levosimendan may improve weaning outcomes in venoarterial ECMO patients. ASAIO J. 2013;59:554–7.CrossRefPubMed

36.

Petroni T, Harrois A, Armour J, et al. Intra-aortic balloon pump effects on macrocirculation and microcirculation in cardiogenic shock patients supported by venoarterial extracorporeal membrane oxygenation. Crit Care Med. 2014;42:2075–82.CrossRefPubMed

37.

Loor G, Simpson L, Parulekar A. Bridging to lung transplantation with extracorporeal circulatory support: when or when not? J Thorac Dis. 2017;9:3352–61. https://doi.org/10.21037/jtd.2017.08.117.CrossRefPubMedPubMedCentral

38.

Rajagopal K, Hoeper MM. State of the art: bridging to lung transplantation using artificial organ support technologies. J Heart Lung Transplant. 2016;35:1385–98.CrossRefPubMed

39.

Mangi AA, Mason DP, Yun JJ, Murthy SC, Pettersson GB. Bridge to lung transplantation using short-term ambulatory extracorporeal membrane oxygenation. J Thorac Cardiovasc Surg. 2010;140:713–5.CrossRefPubMed

40.

Narm KS, Lee S, Suh JW, et al. Risk factor analysis for intraoperative extracorporeal membrane oxygenation weaning failure after lung transplantation. Ann Thorac Surg. 2018;105:242–8.CrossRefPubMed

41.

Ius F, Tudorache I, Warnecke G. Extracorporeal support, during and after lung transplantation: the history of an idea. J Thorac Dis. 2018;10:5131–48. https://doi.org/10.21037/jtd.2018.07.43.CrossRefPubMedPubMedCentral

42.

Hartwig MG, Walczak R, Lin SS, Davis RD. Improved survival but marginal allograft function in patients treated with extracorporeal membrane oxygenation after lung transplantation. Ann Thorac Surg. 2012;93:366–71.CrossRefPubMed

43.

Urban M, Siddique A, Merritt-Genore H, Um J. What are the results of veno arterial extracorporeal membrane oxygenation bridging to heart transplantation? Interact Cardiovasc Thorac Surg. 2019;29:632–4. https://doi.org/10.1093/icvts/ivz096.CrossRefPubMed

44.

Zalawadiya S, Fudim M, Bhat G, Cotts W, Lindenfeld J. Extracorporeal membrane oxygenation support and post-heart transplant outcomes among United States adults. J Heart Lung Transplant. 2017;36:77–81. https://doi.org/10.1016/j.healun.2016.10.008.CrossRefPubMed

45.

Fukuhara S, Takeda K, Kurlansky PA, Naka Y, Takayama H. Extracorporeal membrane oxygenation as a direct bridge to heart transplantation in adults. J Thorac Cardiovasc Surg. 2018;155:1607-1618.e6. https://doi.org/10.1016/j.jtcvs.2017.10.152.CrossRefPubMed

46.

Jahanyar J, Liao JM, Zhang N, et al. Heart transplantation with ECMO bridging: survival differences in the era of the new heart allocation policy. J Heart Lung Transplant. 2019;38:S389–90. https://doi.org/10.1016/j.healun.2019.01.992.CrossRef

47.

Guha A, Hannawi B, Cruz-Solbes AS, et al. Implication of ventricular assist devices in extracorporeal membranous oxygenation patients listed for heart transplantation. J Clin Med. 2019;8:572. https://doi.org/10.3390/jcm8050572.CrossRefPubMedPubMedCentral

48.

Mulaikal TA, Nakagawa S, Prager KM. Extracorporeal membrane oxygenation bridge to no recovery. Circulation. 2019;139:428–30.CrossRefPubMed

49.

MacLaren G. When to initiate ECMO with low likelihood of success. Crit Care. 2018;22:217.CrossRefPubMedPubMedCentral

50.

Abrams DC, Prager K, Blinderman CD, Burkart KM, Brodie D. Ethical dilemmas encountered with the use of extracorporeal membrane oxygenation in adults. Chest. 2014;145:876–82.CrossRefPubMed

51.

Bein T, Brodie D. Understanding ethical decisions for patients on extracorporeal life support. Intensive Care Med. 2017;43:1510–1.CrossRefPubMedPubMedCentral

52.

Pooboni S, Goyal V, Oza P, Kapoor PM. ECMO challenges and its future: indian scenario. J Card Crit Care TSS. 2017;01:89–94. https://doi.org/10.1055/s-0038-1626672.CrossRef

53.

Lorusso R, Shekar K, MacLaren G, et al. ELSO interim guidelines for venoarterial extracorporeal membrane oxygenation in adult cardiac patients. ASAIO J. 2021;67:827–44. https://doi.org/10.1097/MAT.0000000000001510.CrossRefPubMed

54.

Tonna JE, Abrams D, Brodie D, et al. Management of adult patients supported with venovenous extracorporeal membrane oxygenation (VV ECMO): guideline from the Extracorporeal Life Support Organization (ELSO). ASAIO J. 2021;67:601–10. https://doi.org/10.1097/MAT.0000000000001432.CrossRefPubMedPubMedCentral

Title: Discontinuation of ECMO—a review with a note on Indian scenario
Authors: Arpan Chakraborty
Hirak Subhra Majumdar
Writuparna Das
Dipanjan Chatterjee
Kunal Sarkar
Publication date: 04-02-2023
Publisher: Springer Nature Singapore
Keywords: ECMO
ECMO
Published in: Indian Journal of Thoracic and Cardiovascular Surgery / Issue Special Issue 1/2023
Print ISSN: 0970-9134
Electronic ISSN: 0973-7723
DOI: https://doi.org/10.1007/s12055-022-01453-9

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Discontinuation of ECMO—a review with a note on Indian scenario

Abstract

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Special Issue 1/2023

Ambulatory short-term mechanical circulatory support: facilitates recovery and prepares patients for definitive therapy

Mechanical circulatory support — the field is thin !

Myocardial recovery following left ventricular assist device implantation

Futuristic perspectives: novel MCS devices

Pediatric mechanical circulatory support — a review

Veno-venous extracorporeal membrane oxygenation for the treatment of respiratory compromise