Veno-Arterial ECMO Weaning Failure in the Operating Room: Have You Considered Preweaning Bronchoscopy?

Artificial Organs
Markus LuediGabor Erdoes

Abstract

Current guidelines on postcardiotomy veno-arterial extracorporeal oxygenation ECMO (vaECMO) do not mention the assessment of pulmonary function, especially prior to the weaning procedure in the operation room (OR). Mucociliary dysfunction, a nearly ubiquitous finding among mechanically ventilated patients, might put these patients at risk for potential airway problems and associated weaning failure at the time of vaECMO weaning in the OR. In conformity to veno-venous ECMO management, we suggest routine bronchoscopy with bronchial hygiene in the ICU prior to vaECMO weaning in the OR. Likewise, an assessment of patient pleura for effusions should be routinely performed. Although cardiac and respiratory failure often co-exist and there are multiple causes of respiratory failure in patients who require vaECMO, we anticipate that vaECMO patients would significantly benefit from an expanded focus on the pulmonary function and possible respiratory mucous congestion. A routine preweaning bronchoscopy would reduce the frequency of weaning failures in this particular setting, especially in those patients with successfully restored cardiac function.

Citations

Jan 27, 2019·Artificial Organs·Paul S Malchesky
May 13, 2020·Critical Care : the Official Journal of the Critical Care Forum·Aurélien RoumyMatthias Kirsch
Dec 23, 2020·Artificial Organs·Flavio Pola Dos ReisPaulo Manuel Pêgo-Fernandes

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