AI Article Synopsis
- The study investigates the effectiveness of Pump-controlled retrograde trial off (PCRTO) as a safe weaning method from Venoarterial Extracorporeal Membrane Oxygenation (VA-ECMO) by monitoring heart function through a pulmonary artery flotation catheter (PAFC).
- Out of 20 adult patients undergoing PCRTO, 65% successfully weaned off ECMO, while the remaining 35% required further assistance or did not survive past 48 hours; notable differences in heart rate and pulmonary artery wedge pressure were observed between these groups during the trial.
- Results suggest that PCRTO, in conjunction with hemodynamic monitoring, is a reliable method for weaning patients from VA-ECMO
Article Abstract
Objectives: Pump-controlled retrograde trial off (PCRTO) has been recently proposed as an effective and safe VA-ECMO weaning method. However, reports of haemodynamic monitoring during PCRTO are rare. Therefore, the purpose of this study was to investigate the changes in the left and right heart function during the PCRTO process combined with a pulmonary artery flotation catheter (PAFC).
Methods: Between March 2019 and May 2021, 20 adult VA-ECMO patients who underwent PCRTO in combination with PAFC were enrolled in this study. The patients' general characteristics, PCRTO results, haemodynamic parameters during PCRTO progression, complications, and clinical prognoses were analysed. Those who survived for 48 h after withdrawal and did not require ECMO assistance were defined as the success group, and those who did not survive for 48 h after withdrawal or who required ECMO assistance were defined as the failure group.
Results: Of the 20 patients, 13 (65%) were included in the success group, and 7 (35%) were included in the failure group. Compared with the success group, the heart rate (HR) of the failure group was significantly increased 30 min after PCRTO ( < .01), and the pulmonary artery wedge pressure (PAWP) was significantly higher at all time points ( < .01). Compared with pre-PCRTO in the success group, the HR at 2 min in the success group was significantly increased, but decreased to the baseline levels at 15 min and 30 min. The PAWP was also significantly increased at 2 min, but decreased at 15 min and dropped to the baseline level at 30 min in the success group. Compared with pre-PCRTO in the failure group, the HR and PAWP increased significantly at 2 min, 15 min and 30 min in the failure group. No new embolism-related complications were found in the success group after the withdrawal from ECMO.
Conclusions: PCRTO is a safe and reliable VA-ECMO weaning method. Combined with haemodynamic monitoring through PAFC, PCRTO can better assess the cardiac reserve function.
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| http://dx.doi.org/10.1177/02676591211054976 | DOI Listing |
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