Table 7:

Suggested approach to weaning from VV ECMO via reduction of gas flow with preserved higher blood flows

Step	Purpose	Process
1	Reduce fraction of delivered oxygen (FDO2)	■ Stepwise reduction in FDO2 from 1.0 to 0.21 in decrements of approximately 20%. ■ Maintain acceptable SpO2 > 92% or PaO2 of at least ≥ 70 mmHg ■ ABG as clinically indicated
2	Reduce sweep gas	■ Stepwise reduction in sweep gas flow rate by 0.5 – 1 L/min to goal of 1 L/min ■ Check ABG with each decrement in sweep gas flow rate ■ Maintain acceptable pH based on the patient’s clinical condition without excessive work of breathing
3	Off-sweep gas challenge	■ If patient able to tolerate discontinuation of ECMO, trial off sweep gas for 2–3 hours or longer. ■ Monitor SpO2 ■ Check ABG off sweep gas after allotted time
4	Prepare for decannulation	■ Notify surgeon or whomever decannulates. ■ Confirm off-sweep gas ABG demonstrates PaO2 ≥ 70 mmHg and acceptable pH based on the patient’s clinical condition without excessive work of breathing ■ Nil per os/nothing by mouth status ■ Active blood type (ABO) & antibody screen in case of significant blood loss ■ Prepare to give sedation depending on patients’ pre-decannulation sedation status. ■ Hold heparin for at least 1 hour prior to decannulation. ■ Trendelenburg position if jugular vein cannula ■ Close cannulation site with a suture, apply slight compression dressing and observe carefully ■ Check for deep vein thrombosis after 24 hours