Podcast: Play in new window | Download

Subscribe: Apple Podcasts | RSS

Hi, it’s Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care.

Today’s tip is about ECMO weaning in intensive care, more specifically VA ECMO weaning. So there’s a difference between VA and VV ECMO. VA ECMO is for heart failure. VV ECMO is for lung failure. This particular client we’re working with at the moment has heart failure and lung failure and is on VA ECMO at the moment.

The history is a heart attack with an LAD (left anterior descending artery) stent and other vessels blocked, but the client was too unstable after the heart attack to go for another stent or have cardiac surgery. So he ended up on ECMO and VA ECMO and inotropes/vasopressors very quickly whilst he was going into lung failure, as well as part of COVID.

How should weaning be done when someone is on VA ECMO? Well, the weaning should be done by reducing the revs per minute (RPM) and by reducing the cardiac output and therefore after the heart had a rest for a few days or for a couple of days, and then let the heart beat for itself, let the heart pump for itself and then gradually wean off ECMO. So that is what needs to happen in a nutshell.

In this particular situation with our client, it’s a very tricky situation because the intensive care team now has also started to use the intra-aortic balloon pump (IABP) again, which I haven’t seen actually before. The intra-aortic balloon pump (IABP), if it’s not working after a heart attack or after cardiac surgery, if it’s not enough support for the heart, usually leads to VA ECMO.

In this situation, they’re trying to reverse the course of action. They’re now trying to wean off ECMO whilst inserting the intra-aortic balloon pump to support the heart, but that’s from my perspective. It’s not a good sign because when you wean off ECMO, the heart should be pumping by itself.

So it’s definitely a red flag and it looks to me like the intensive care team in this situation might be actually clutching at straws. And hasn’t actually, the family told that, it might be a futile attempt, unfortunately, but the next few days would indicate what the weaning of ECMO shows.

The trouble with ECMO is it’s a great device and it helps save lives, bridge to heart transplant, bridge to the heart recovering without a transplant but the trouble is, it’s a huge infection risk. Often hemoglobin drops because blood is being withdrawn from the body, of course, going through the ECMO machine. So there’s definitely some loss of blood there. So it comes with massive risks that need to be managed, but it also has a limited timeline where you can use ECMO because of the massive risks that are attached to it.

So weaning off ECMO should be done without the intra-aortic balloon pump (IABP). That is my quick tip for today. Once I know more about what the next steps are for the client, I’ll post another video here.

If you have a loved one in intensive care, go to intensivecarehotline.com, ring us on one of the numbers on the top of the website, or send me an email to [email protected].

Like this video, comment down below what you want to see next, or any questions that you have and subscribe to my YouTube channel for families in intensive care.

This is Patrik Hutzel from intensivecarehotline.com and I’ll talk to you in a few days.