Safety and Feasibility of a Protocolized Daily Assessment of Readiness for Liberation from Venovenous Extracorporeal Membrane Oxygenation.

Gannon, Whitney D; Stokes, John W; Bloom, Sarah; Sherrill, Wren; Bacchetta, Matthew; Rice, Todd W; Semler, Matthew W; Casey, Jonathan D

BACKGROUND Decannulation from venovenous extracorporeal membrane oxygenation (VV-ECMO) at the earliest and safest possible time may improve outcomes and reduce cost. Yet, there are no prospective studies comparing weaning strategies for liberation from ECMO. RESEARCH QUESTION Is a protocolized daily assessment of readiness to liberate from VV-ECMO safe and feasible? STUDY DESIGN AND METHODS We conducted a prospective, single-arm, safety and feasibility study of a protocol for daily assessment of readiness to liberate from VV-ECMO among consecutive adult patients receiving VV-ECMO across four intensive care units at a single center between June 20, 2020 and November 24, 2020. The ECMO-free protocol included three-phases: 1) the safety screen, 2) non-ECMO fraction of inspired oxygen titration, and 3) the ECMO-free trial. Enrollment, interventions, and data collection were performed prospectively by trained study staff. RESULTS Twenty-six patients received the ECMO-free protocol on 385 patient-days. The safety screen was passed during a total of 59 ECMO-free daily assessments (15.3%) among 20 patients. Every passed safety screen proceeded to an ECMO-free trial. There were 28 (47.5%) passed ECMO-free trials among 16 patients (61.5%). There were no missed safety screens, protocol deviations, or adverse events. Of the 16 patients who passed an ECMO-free trial, 14 (87.5%) were decannulated. Among decannulated patients, 12 (85.7%) were decannulated on the same day as a passed ECMO-free trial, 6 (42.9%) were decannulated on the first day that they passed an ECMO-free trial, and 6 (42.9%) passed an ECMO-free trial at least twice consecutively before decannulation. The median time from first passed ECMO-free trial to decannulation was 2 days (IQR, 0 to 3 days). INTERPRETATIONS The ECMO-free protocol is feasible and may identify patients for decannulation earlier than gradual approaches to weaning.