18, 11, 70, 71, 72, 73, 74, 75
The most important single paper for how this subject should be taught. It separates two questions that protocols conflate - can the circuit come out, and will this patient survive - and shows that the entire predictive literature answers only the first. Practical consequences: decide whether re-cannulation is possible BEFORE decannulating, and make the destination decision early enough to transfer the patient while transfer is still possible.
Not applicable
DOI 10.1177/02676591221115938
Not applicable - synthesis and critique of weaning strategies
Narrative review, no systematic search or quantitative synthesis. The up-to-70% mortality figure is the review's own framing and its primary source was not retrieved; it should be read as the upper end of a range rather than a central estimate. No numerical thresholds are specified.
THE CENTRAL FINDING: a strikingly high mortality up to 70% after initial successful weaning raises concerns about the validity of current weaning strategies. Despite successful circuit removal many patients subsequently die, so the criteria for weaning readiness inadequately predict long-term survival. The authors advocate a patient-tailored approach including a bailout strategy when weaning fails, integrating echocardiographic assessment, haemodynamic predictors and clinical judgement rather than protocol-driven criteria alone. They emphasise examining left AND right ventricular function and interdependence, and the temporal course of cardiac recovery as a function of extracorporeal support, with RV coupling to the pulmonary circulation prognostically important. When weaning fails they recommend predetermined contingency plans rather than urgent unprepared re-cannulation. Patients at high risk of weaning failure should be identified early, enabling timely transportation to an advanced heart failure centre.
Adults on VA ECMO for cardiogenic shock being considered for weaning. Perfusion 2023;38(7):1349-1359. Retrieved in full.