Suggestions for weaning patients from VA ECMO^[1,2]

VA: venoarterial; ECMO: extracorporeal membrane oxygenation; MAP: mean arterial pressure; HR: heart rate; CVP: central venous pressure; LV: left ventricular; RV: right ventricular; TTE: transthoracic echocardiography; TEE: transesophageal echocardiography; PaO₂: arterial partial pressure of oxygen; FiO₂: fraction of inspired oxygen; ACT: activated clotting time; CO: cardiac output; CI: cardiac index; MCS: mechanical circulatory support; LVEF: left ventricular ejection fraction; CVO₂: central venous blood oxygen content; RR: respiratory rate; bpm: beats per minute; PIP: peak inspiratory pressure; PEEP: positive end-expiratory pressure; VV: venovenous.
* Refer to UpToDate content regarding extracorporeal membrane oxygenation. Note that there are patient-dependent and institution-dependent variations in weaning protocols. Most centers implement weaning protocols during daytime hours when clinicians with appropriate expertise are available.
¶ Further increases in inotropic support may be appropriate if weaning criteria are not met when decannulation is necessary due to evidence of vascular complications.
Δ Sweep speed is defined as the rate that oxygen is delivered via the ECMO circuit.
◊ Transition from VA ECMO to VV ECMO can be considered if biventricular function has recovered, but respiratory function remains inadequate.