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I want to know how to wean your critically ill loved one off the ECMO (Extracorporeal Membrane Oxygenation) machine when they are on VA ECMO (Veno-Arterial Extracorporeal Membrane Oxygenation) for heart failure, stay tuned! I will give a case study today.

Currently, we are working with a client who has their dad in ICU on VA ECMO for heart failure after cardiac arrest. Here’s the current situation, the client has been on VA ECMO for heart failure for a few days now, and she wants to know what the steps are to wean him off VA ECMO.

My name is Patrik Hutzel from intensivecarehotline.com, and this is another quick tip for families in intensive care.

A number of things need to take place when someone is being weaned off VA ECMO in intensive care for heart failure. First off, the function of the heart itself needs to improve. What that means is, for example, the heart is very weak, which is one of the reasons why someone goes on VA ECMO in the first place, and then the support from the ECMO needs to be managed. For example, the flow needs to be reduced, for this particular client, the flow was 4.2 L/min a few days ago. Now, they’ve weaned it down to 3.5 L/min, which is good. The RPM (rest per minute) are 3,000 at the moment and they have been reduced from 3,500 a few days ago, that is also a good thing.

Other things that need to be monitored is obviously cardiac function, i.e. the ejection fraction. Ejection fraction refers to the contractility of the heart or the pump function of the heart. Currently, the ejection fraction is only 20 to 22%, and that needs to improve. The client is also on lidocaine and amiodarone infusion to maintain a regular heart rhythm, a sinus rhythm. That also needs to be weaned off step by step to make sure that the heart can pump or beat in a regular sinus rhythm instead of being in an irregular rhythm, making it more likely that the patient has another cardiac arrest or heart attack.

Next, the patient needs to be off inotropes and vasopressors, which has already been achieved for this particular patient already. He’s been off norepinephrine for a few days and ideally, he stays off the inotropes and vasopressors, again, to support independent cardiac function.

Furthermore, other things that need to be monitored when someone is on VA ECMO are the pressures of the filter. When the blood is running through the ECMO machine, it’s run through a filter. If that filter clots, that would be very detrimental for the patient and could cause another cardiac arrest. Therefore, the patient is on a heparin infusion to make sure the blood isn’t clotting.

So, aPTT (activated partial thromboplastin time) needs to be checked daily to make sure it is within the therapeutic limit so that the filter doesn’t clot. But by the same token, you don’t want aPTT too high, so that the patient isn’t starting to bleed.

Once that is all achieved, the flow of ECMO, like I said, needs to be gradually reduced. Also, the sweep gas flow needs to be reduced. The sweep gas is responsible for removing CO2 (carbon dioxide) from the blood that’s running through the ECMO machine. Also, regular ECGs (electrocardiogram) need to be done to make sure, again, it’s a regular sinus rhythm. Regular ultrasounds of the heart need to be done, checking ejection fraction.

In some scenarios, you also want to have a Swan-Ganz catheter so you can check cardiac output and cardiac index. That’s not happening for all ECMO patients, but I know some ICUs are also using a Swan-Ganz catheter to measure cardiac output and cardiac index, once again, to make sure the heart is in a position to independently beat and have the right stroke volume and ejection fraction to work independently to maintain organ perfusion across the board. Once all of that is achieved, then the next step is to wean the patient off the ventilator. That can also happen step by step.

Once the patient is off ECMO and is also off heparin, that’s also the point where if the patient can’t be weaned off the ventilator, a tracheostomy might be the right thing to do. When heparin has been stopped, if the patient can’t be weaned off the ventilator after about 10 to 14 days on the ventilator with a breathing tube. Sedation should also be minimized, and opiates should be minimized and ideally should be stopped as well.

I have worked in critical care nursing for 25 years in three different countries where I worked as a nurse manager for over 5 years. I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com. I can very confidently say that we have saved many lives for our clients in intensive care. You can verify that in our testimonial section and you can verify it on our intensivecarehotline.com podcast section.

That’s one of the many reasons why we have helped hundreds and hundreds of members and clients over the years to improve their lives instantly when they have a loved one in intensive care, making sure they can make informed decisions, have peace of mind, control, power, and influence, making sure the loved one gets the best care and treatment always.

That’s also why I do one on one consulting and advocacy over the phone, Zoom, Skype, WhatsApp, whichever medium works best for you. I talk to you and your families directly. I handhold you through this once in a lifetime situation, and you simply cannot afford to get wrong. I also talk to doctors and nurses directly with you or on your behalf, and I ask all the questions that you haven’t even considered asking but must be asked when you have a loved one critically ill in intensive care to hold them accountable. 

I also represent you in family meetings with intensive care teams.

We also do medical record reviews in real time so that you can get a second opinion in real time. We also do medical record reviews after intensive care if you have unanswered questions, if you need closure, or if you are suspecting medical negligence.

We also have a membership for families of critically ill patients in intensive care. You can become a member if you go to intensivecarehotline.com if you click on the membership link or if you go to intensivecaresupport.org directly. In the membership, you have access to me and my team, 24 hours a day, in the membership area and via email, and we answer all questions intensive care related. You also have exclusive access to 21 eBooks and 21 videos that I’ve personally written and recorded, making sure you make informed decisions, have peace of mind, control, power, and influence, so that your loved one gets best care and treatment always.

All of that you get at intensivecarehotline.com. Call us on one of the numbers on the top of our website or simply send us an email to [email protected] with your questions.

If you like my videos, subscribe to my YouTube channel for regular updates for families in intensive care. Click the like button, click the notification bell, share the video with your friends and families, and comment below what you want to see next, what questions and insights you have.

I also do a weekly YouTube live where I answer your questions live on the show and you will get notification for the YouTube live if you’re a subscriber to my YouTube channel or if you are a subscriber to my intensivecarehotline.com email newsletter.

Thank you so much for watching.

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

Thank you.

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