Extubate Before Venovenous Extracorporeal Membranous Oxygenation Decannulation or Decannulate While Remaining on the Ventilator? The EuroELSO 2019 Weaning Survey

Swol, J., Shekar, K., Protti, A., Tukacs, M., Broman, L. M., Barrett, N. A., Mueller, T., Peek, G. J., & Buscher, H. (2021). ASAIO journal (American Society for Artificial Internal Organs : 1992), 67(4), e86–e89. https://doi.org/10.1097/MAT.0000000000001237

Introduction: Patients who receive venovenous extracorporeal membrane oxygenation (VV ECMO) support upon failure of invasive mechanical ventilation (IMV) and other adjuncts, including low tidal volume, prone positioning, adjusted positive end-expiratory pressure, and lung recruitment maneuvers, typically remain on IMV after VV ECMO commencement. Once both IMV and VV ECMO support are initiated, it is unclear which modality should be weaned first. Moreover, the optimal IMV settings, risk versus benefits of early spontaneous breathing, and optimal timing of VV ECMO weaning practices are yet to be defined. In addition, although the practice of liberation from IMV during ECMO has been increasing, the data concerning the weaning processes from ECMO and IMV are limited.