Weaning and Liberation From V-V ECMO

Weaning from the extracorporeal support represents the ultimate objective of assistance. Native lung function must have recovered to a certain degree to make weaning possible, and a weaning trial is performed to ascertain the patient’s independence from extracorporeal membrane oxygenation (ECMO). This test can be performed in various ways, the common feature being a progressive increase in the respiratory workload. Once the patient has succeeded a weaning trial, decannulation can occur. This can be performed surgically or with direct decannulation, depending on the cannulation techniques and patient’s characteristics. Not all patients are ultimately weaned off ECMO. While for some patients (e.g., those bridged to lung transplant) this might be evident from the beginning, in some others the extracorporeal support can become a bridge to nowhere and futility ensues. In these patients, ECMO should be discontinued while ensuring patients’ comfort. Weaning represents a very challenging period, and even once decannulation has been obtained complications can occur, and those must be prevented and promptly treated.