Pump-controlled retrograde trial off for weaning from venoarterial extracorporeal membrane oxygenation in an adult patient with pulmonary embolism

Kazuki Matsumura; Takeo Matsuyoshi; Yuichi Horikoshi; Junichi Sasaki; Keiki Shimizu

doi:10.1002/ams2.809

Pump-controlled retrograde trial off for weaning from venoarterial extracorporeal membrane oxygenation in an adult patient with pulmonary embolism

Acute Med Surg. 2022 Dec 11;9(1):e809. doi: 10.1002/ams2.809. eCollection 2022 Jan-Dec.

Authors

Kazuki Matsumura^{1

2}, Takeo Matsuyoshi¹, Yuichi Horikoshi¹, Junichi Sasaki², Keiki Shimizu¹

Affiliations

¹ Department of Emergency and Critical Care Medicine, ECMO Center Tokyo Metropolitan Tama Medical Center Fuchu Tokyo Japan.
² Department of Emergency and Critical Care Medicine Keio University School of Medicine Shinjuku Tokyo Japan.

Abstract

Background: Although pump-controlled retrograde trial off (PCRTO) is a practical method for weaning from venoarterial extracorporeal membrane oxygenation (VA-ECMO), its advantages and safety for patients with pulmonary embolism are not yet reported.

Case presentation: A 62-year-old man with coronavirus disease 2019 experienced sudden cardiac arrest, and VA-ECMO was introduced. After confirming a massive acute pulmonary embolism, unfractionated heparin treatment was initiated. On day 6, the patient was confirmed stable with a flow rate of 1.0 L/min. However, decannulation led to cardiac arrest and reintroduction of VA-ECMO. After further treatment, a residual thrombus was observed, and pulmonary arterial pressure remained high. On day 23, ECMO was decannulated successfully after a weaning test with PCRTO, which simulated ECMO withdrawal by generating a partial arteriovenous shunt.

Conclusion: PCRTO is a feasible weaning strategy and can be considered for patients with uncertain cardiorespiratory recovery.

Keywords: COVID‐19; extracorporeal membrane oxygenation; hemodynamics; pulmonary embolism; safety.

Publication types

Case Reports