Weaning from VA
#ECMO: which approach best reflects true cardiopulmonary reserve??
🔄 PCRTO: retrograde flow through pump, creating controlled VA shunt mimicking native physiology (with regular
#POCUS invasive PAC monitoring), challenging RV reducing LV afterload enabling assessment of native lung function
🔍 pilot study: pump-controlled retrograde trial off feasibility, safety, physiological insights vs conventional weaning (reducing EBF to around 1 LPM, leaving residual RV unloading/LV afterload)
🫀 criteria for readiness-to-wean: resolution of underlying cause of CS, evidence of improving renal/hepatic perfusion, lactate < 2 mmol/L, MAP > 60 mmHg, pulse pressure > 15 mmHg, improving LVOT VTI, absence of severe mitral or tricuspid regurgitation
PCRTO appeared feasible, safe, informative complement to conventional weaning. In scenarios with advanced cardiac disease/borderline cases, its loading challenge added relevant information that impacted decision-making on short and long-term strategies ie
- unmasking RV failure, biventricular compromise, respiratory deterioration prompting additional optimization
- unmasking underlying defects enabling pre-explant repair
- confirming stable haemodynamics/pulmonary function supporting safe weaning, avoiding premature escalation to durable
#MCS
@Crit_Care
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