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Abstract

Objectives

Pump-controlled retrograde trial off (PCRTO) has been recently proposed as an effective and safe VA-ECMO weaning method. However, reports of haemodynamic monitoring during PCRTO are rare. Therefore, the purpose of this study was to investigate the changes in the left and right heart function during the PCRTO process combined with a pulmonary artery flotation catheter (PAFC).

Methods

Between March 2019 and May 2021, 20 adult VA-ECMO patients who underwent PCRTO in combination with PAFC were enrolled in this study. The patients' general characteristics, PCRTO results, haemodynamic parameters during PCRTO progression, complications, and clinical prognoses were analysed. Those who survived for 48 h after withdrawal and did not require ECMO assistance were defined as the success group, and those who did not survive for 48 h after withdrawal or who required ECMO assistance were defined as the failure group.

Results

Of the 20 patients, 13 (65%) were included in the success group, and 7 (35%) were included in the failure group. Compared with the success group, the heart rate (HR) of the failure group was significantly increased 30 min after PCRTO (p < .01), and the pulmonary artery wedge pressure (PAWP) was significantly higher at all time points (p < .01). Compared with pre-PCRTO in the success group, the HR at 2 min in the success group was significantly increased, but decreased to the baseline levels at 15 min and 30 min. The PAWP was also significantly increased at 2 min, but decreased at 15 min and dropped to the baseline level at 30 min in the success group. Compared with pre-PCRTO in the failure group, the HR and PAWP increased significantly at 2 min, 15 min and 30 min in the failure group. No new embolism-related complications were found in the success group after the withdrawal from ECMO.

Conclusions

PCRTO is a safe and reliable VA-ECMO weaning method. Combined with haemodynamic monitoring through PAFC, PCRTO can better assess the cardiac reserve function.

Keywords

pulmonary artery flotation catheter pulmonary artery wedge pressure extracorporeal membrane oxygenation haemodynamics

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References

Keebler

Haddad

Choi

, et al. Venoarterial extracorporeal membrane oxygenation in cardiogenic shock. JACC Heart Failure 2018; 6: 503–516.

Rihal

Naidu

Givertz

, et al. 2015 SCAI/ACC/HFSA/STS clinical expert consensus statement on the use of percutaneous mechanical circulatory support devices in cardiovascular care (endorsed by the American Heart Association, the cardiological society of India, and Sociedad Latino Americana de Cardiologia Intervencion; Affirmation of Value by the Canadian Association of Interventional Cardiology-Association Canadienne de Cardiologie d'intervention). J Card Fail 2015; 21: 499–518.

Lusebrink

Stremmel

Stark

, et al. Update on weaning from veno-arterial extracorporeal membrane oxygenation. J Clin Med 2020; 9: 992.

Smith

Vukomanovic

Brodie

, et al. Duration of veno-arterial extracorporeal life support (VA ECMO) and outcome: an analysis of the Extracorporeal Life Support Organization (ELSO) registry. Crit Care 2017; 21: 45.

Ortuno

Delmas

Diehl

, et al.

Weaning from veno-arterial extra-corporeal membrane oxygenation: which strategy to use?

Ann Cardiothorac Surg 2019; 8: E1–E8.

Fiser

Tribble

Kaza

, et al. When to discontinue extracorporeal membrane oxygenation for postcardiotomy support. Ann Thorac Surg. 2001; 71: 210–214.

Westrope

Harvey

Robinson

, et al. Pump controlled retrograde trial off from VA-ECMO. ASAIO Journal 2013; 59: 517–519.

Ling

Chan

. Weaning adult patients with cardiogenic shock on veno-arterial extracorporeal membrane oxygenation by pump-controlled retrograde trial off. Perfusion 2018; 33: 339–345.

Lim

Lee

, et al. Early experience of pump-controlled retrograde trial off for weaning from veno-arterial extracorporeal membrane oxygenation in adult patients with cardiogenic shock. Perfusion 2021; 36: 401–406.

10.

Jia

Liu

, et al. [Application of pump-controlled retrograde trial off in weaning from veno-arterial extracorporeal membrane oxygenation in adult patients]. Zhonghua Yi Xue Za Zhi 2020; 100: 1544–1550.(in China)

11.

. Pulmonary artery flotation catheter combined with pump-controlled retrograde trial off as a trial for weaning from veno-arterial extracorporeal membrane oxygenation: a case report. Perfusion 2019; 34: 519–522.

12.

Holgren

Frede

Crumley

, et al. Novel utilization of the bridge during weaning off venoarterial ECMO: the Hoffman Clamp Method. Innovations 2016; 11: 229–231.

13.

Gaies

Gurney

Yen

, et al. Vasoactive-inotropic score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass. Pediatr Crit Care Med 2010; 11: 234–238.

14.

Pandya

Daley

Mattke

, et al. A comparison of pump-controlled retrograde trial off to arterio-venous bridging for weaning from venoarterial extracorporeal membrane oxygenation. Eur J Cardiothorac Surg 2019; 56: 277–284.

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Pulmonary artery flotation catheter (PAFC) combined with pump-controlled retrograde trial off (PCRTO) as a trial for weaning VA-ECMO patients: A retrospective study