Extracorporeal Membrane Oxygenation for Pregnant and Postpartum Patients

Michael J. Wong, MD; Shobana Bharadwaj, MBBS; Jessica L. Galey, MD; Allison S. Lankford, MD; Samuel Galvagno, DO, PhD; Bhavani Shankar Kodali, MD

Disclosures

Anesth Analg. 2022;135(2):277-289. 

In This Article

Discontinuation of ECMO Support

Scant data exist to guide strategies for weaning ECMO, so practice is highly variable.[96–98] As in nonpregnant patients, weaning commences alongside clinical evidence of native organ recovery, and ECMO settings (ie, sweep gas flow, sweep FIO 2, and ECMO flow) are progressively reduced until a trial off ECMO is attempted. The presence of new or worsened abnormalities in the fetal heart rate tracing on reducing ECMO parameters provides additional feedback to direct the weaning process, potentially indicating a need to restore previous settings.

Decannulation typically takes place at the bedside for VV-ECMO after the patient is demonstrated to tolerate a minimal sweep gas flow (ie, 0–1 L/min) while on acceptable ventilator settings. For VA-ECMO, decannulation is performed in the operating room pending echocardiographic assessment of valvular and biventricular function; during weaning, ECMO flow is decreased by 500 mL every 5 to 10 minutes until reaching a minimum flow of 1 L/min. Barring cardiac decompensation after another 5 minutes, decannulation may occur, often with the aid of a percutaneous closure device.

processing....