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Venovenous and venoarterial extracorporeal membrane oxygenation has become a more popular topic and treatment over the last several years. More patients are being placed on ECMO for multiple different reasons. Weaning patients from ECMO is a very broad topic with multiple different approaches. This activity will discuss the technique along with the roles of the associated teams when weaning a patient from venovenous (VV) or venoarterial (VA) ECMO. Objectives: Outline the complications with weaning a patient who is not ready to wean from ECMO. Describe the equipment, personnel, preparation, and technique in regards to weaning a patient from ECMO. Identify when a patient can be weaned from venovenous (VV) or venoarterial (VA) ECMO. Summarize interprofessional team strategies for improving care coordination with weaning patients from ECMO. Access free multiple choice questions on this topic.

Extracorporeal life support (ECLS), which is also known as extracorporeal membrane oxygenation (ECMO), is essentially a functioning heart and lung machine for a patient in whom their own anatomy or physiology is impaired. ECMO can be used for many different pathologies, which may require either venovenous (VV) or venoarterial (VA) for the support of the patient. ECMO can provide a bridge for the patient to resolve their disease process or provide the patient time to receive a long-term device or transplant. The ideas of ECMO have been around for years. Until recently, we as a healthcare team have started to master the use of ECMO and truly learned how to administer this artificial oxygenation machine. The entire process of ECMO requires a large, very well-organized team that can provide cannulation, management of the ECMO machine, weaning the patient, decannulation, and any possible complication that can arise. This article will focus on weaning adult and pediatric patients from ECMO.

Weaning patients when they are not deemed candidates to be weaned or potential candidates that wean well for the first several hours can still have associated complications. Bleeding Ischemia to limbs End organ hypoperfusion Neurological complications Infections

ECMO has allowed many patients to have life-saving care, which will ultimately give them time to heal their own hearts or lungs. The entire initiation of ECMO with cannulation, day-to-day management, and weaning requires a vast team of professionals with direct lines of communications. Patients who are on ECMO should have daily discussions regarding their potential for possible weaning trials. All members of the interprofessional healthcare team (clinicians, mid-level practitioners, nurses, respiratory therapists) caring for the patient must be aware of attempted trials and be ready for any possible trial, whether it is successful or not. Incorrect or improper communication between the team members could lead to morbidity or mortality when weaning patients from ECMO. When teams are in constant communication, this will enhance patient care and provide better outcomes. Having a detailed plan for weaning and alternative plans if the patient fails the wean or emergently needs to go back on ECMO should have been discussed in depth with all team members with open communication lines to provide the best care. Being prepare for the weaning trials will provide the patient with the best possibility for weaning and decrease morbidity and mortality. [Level 5]

An interprofessional team is needed to care for patients on ECMO. Once the patient has undergone cannulation with the initiation of ECMO, a multi-facet team must step in. There are many moving parts to running VA or VV ECMO. The perfusion team monitors all the ECMO circuit parameters and makes small changes to better oxygenate and remove CO2 on the ECMO circuit. Surgical or medical intensivists monitor the progression of the patient on ECMO and also monitor the ventilator. The intensivists must decide along with other team members when the patient is ready for weaning trials or if they need more time to heal their damaged organs. ICU nurses and ECMO technicians are crucial in their role with the management of the patient as they are at the bedside every day. Rehab specialists, along with PT and OT, can work with the patients to help them regain their strength and potential for weaning from ECMO. Weaning patients from ECMO is not an easy task. Every member of the team is crucial to the success of weaning the patients from the ECMO circuit. Interprofessional interventions and communication are vital to the success and outcome of the patient.

Interprofessional team monitoring is critical to the outcomes of the patient. While a patient is on ECMO, they should be monitored continuously by an ECMO technician who constantly monitors the circuit and looks at the vital signs. They can make small changes to help facilitate better hemodynamic stability for the patient. They must remain in constant contact with the ECMO coordinator and ICU nursing staff to alert the team if any changes arise. All team members must be able to monitor the patient from the perspective of their field and be able to communicate to provide the patient with the best possible outcomes. The patient could have a complication arise at any time. Therefore all team members must be ready to do their part to help with the care of the patient. When all team members are prepared, the patients have better outcomes with less morbidity and mortality.