Table 1 Varied approaches to weaning in the literature
From: Physiological adaptations during weaning from veno-venous extracorporeal membrane oxygenation
Source | Preconditions for weaning | Preferred ventilation | Targeted parameters during weaning | Measured effort/drive | Monitoring criteria for successful trial | |||
|---|---|---|---|---|---|---|---|---|
ECBF (L/min) | FdO2 | SGF (L/min) | Duration (h) | |||||
Sen et al. 2016 [8] | PEEP 5–10, peak pressure 20–25, TV 6 ml/kg, RR ~ 15, PaO2 50–80, radiological improvement | Controlled or spontaneous | 2 | 0.21 | 0 | Unspecified | – | Clinician Discretion |
Reeb et al. 2017 [9] | Sats > 88% (PaO2 > 60), FiO2 ≤ 0.6, PEEP ≤ 15, RR ≤ 35 | Not specified | Unspecified | 1.0 | 0 | 4 | – | Stable ABG |
Combes et al. 2018 [3] | Clinical + radiological improvement | Controlled | Unspecified | 1.0 | 0 |  ≥ 1 | – | PaO2 > 70 mmHg on FiO2 < 0.6 plateau pressure < 30. No acute cor pulmonale |
Broman et al. 2018* [10] | FiO2 0.35–0.55, minimal V’CO2ML with 5% CO2 added to SGF < 2L/min | Controlled or spontaneous | Unspecified | 1.0 | 0 |  ≥ 2–12 | – | Clinician discretion |
Broman et al. 2018†[10] | FiO2 < 0.45, PEEP < 10, peak pressure < 27 | Not specified | 1.5 | 1.0 | 0 | 0.5–1 | – | Stable ABG and absence of dyspnoea |
Broman et al. 2018‡ [10] | Clinical + radiological improvement | Spontaneous | 2.5–3 | 1.0 | 0 | Unspecified | – | Absence of dyspnoea |
Grant et al. 2018 [11] | Sats > 90%, FiO2 ≤ 0.5, PEEP ≤ 10, plateau pressure ≤ 25, TV ≤ 6-8ml/kg | Controlled | 3–4 | 0.21 |  ≤ 1L | Unspecified | – | Stable ABG, maintain preconditions |
Seiler et al. 2018 [12] | Clinician discretion | Controlled | 2 | 1.0 | 0 | 1 | – | Stable ABG |
Chaves et al. 2019 [13] | FiO2 ≤ 0.6, PEEP ≤ 15, peak pressure ≤ 30, TV ≤ 6ml/kg, RR ≤ 35 and radiological improvement | Spontaneous | Unspecified | 1.0 | 0 | 6 | – | Clinical stability, normal pH and PaO2 |
Vasques et al. 2019 [14] | Sats > 88% on FiO2 0.6, PaO2 > 225 on Cilley test, V’CO2NL > 50% of total, TV ≤ 6–8 ml/kg, | Spontaneous | Unspecified | 0.21 | 0 | Unspecified | Yes | P 0.1 > − 10, RR ≤ 35, ratio of V’CO2NL to minute ventilation > 80% of baseline, absence of distress |
Li et al. 2020 [15] | Clinical + radiological improvement | Controlled | 2.5 | 1.0 | 0 | 24–48 | – | RR ≤ 20, P:F ratio > 150, Murray Index 2–3, PaCO2 ≤ 50, temperature < 38c |
Gannon et al. 2021 [16] | SGF ≤ 3, Sats ≥ 88% (PaO2 ≥ 60) with FiO2 ≤ 0.6, PEEP ≤ 15. RR ≤ 35, HR < 120, systolic BP ≥ 180 or < 90, pH ≥ 7.35 | Controlled or spontaneous |  < 3 | 0.5 | 0 | 0.5 | – | Maintain non-ECMO preconditions, ≤ 20% change in HR |
Tonna et al. (ELSO guideline), 202 [6] | PaO2 ≥ 70 FiO2 ≤ 0.6, PEEP ≤ 10, plateau ≤ 28, TV ≤ 6ml/kg, RR ≤ 28, improved CXR | Controlled or spontaneous | 1–1.5** | 0.21 | 0 |  ≥ 2–3 | – | Normocapnia, PaO2 > 70, no respiratory distress |
Teijeiro et al. 2021 [17] | No air leak, No NMB > 24 h, FiO2 ≤ 0.6 Sats > 88% PaO2 > 60 peak pressure ≤ 20, TV ≤ 9ml/kg, haemodynamically stable, SGF < 5, ECBF < 5, | Spontaneous | < 5 | 1.0 | 0 | 2–24 | – | Respiratory distress, TV > 9ml/kg, Sats < 88% (or requiring FiO2 > 0.6, PEEP ≥ 20) pH < 7.25, haemodynamic instability, agitation or drowsiness |
Belliato et al. 2021 [18] | Clinical and radiological improvement, PEEP ≤ 10–15, haemodynamic stability | Controlled or spontaneous | Unspecified | 1.0 | 0 | 6–12 | – | Clinician discretion |
Al-Fares et al. 2021 [19] | Clinician discretion | Controlled or spontaneous |  > 3 | 1.0 | 0 | Unspecified | Yes | Clinician discretion |
Lazarri et al. 2022 [20] | ∆Pes ≤ 15, RR ≤ 30, pH > 7.25, PaCO2 ≤ 60, PaO2 > 70 with FiO2 ≤ 0.6 | Controlled or spontaneous | Unspecified | 1.0 | 0 | Unspecified | Yes | Maintain preconditions |