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J Chest Surg

Published online April 8, 2024

Copyright © Journal of Chest Surgery.

Comparison of Conventional Methods with Pump-Controlled Retrograde Trial off for Weaning Adults with Cardiogenic Shock from Veno-Arterial Extracorporeal Membrane Oxygenation

Jeong-Jun Jo , M.D., Woo Sung Jang , M.D., Ph.D., Namhee Park , M.D., Ph.D., Yun Seok Kim , M.D., Ph.D., Jae Bum Kim , M.D., Kyungsub Song , M.D.

Department of Thoracic and Cardiovascular Surgery, Keimyung University Dongsan Hospital, Keimyung University College of Medicine, Daegu, Korea

Correspondence to:Kyungsub Song
Tel 82-53-258-4783
Fax 82-53-258-4783
E-mail chest.songks@gmail.com
ORCID
https://orcid.org/0000-0002-6556-2261

Received: December 1, 2023; Revised: January 20, 2024; Accepted: January 26, 2024

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: Pump-controlled retrograde trial off (PCRTO) is a safe, simple, and reversible method for weaning patients from veno-arterial extracorporeal membrane oxygenation (VA-ECMO). However, few studies have compared PCRTO to conventional weaning methods. This retrospective study aimed to compare PCRTO to non-PCRTO methods.
Methods: This study included patients who were weaned from VA-ECMO from January 2016 to December 2022 at our medical center. Demographic data, ECMO management, ECMO complications, survival to discharge, and cardiogenic shock after VA-ECMO weaning were compared between the 2 groups.
Results: Seventy patients who were weaned from VA-ECMO using PCRTO and 85 patients who were weaned with conventional methods were compared. Patient characteristics were not significantly different between the 2 groups. The rate of survival to discharge was significantly higher in the PCRTO group than in the non-PCRTO group (90% vs. 72%, p=0.01). The rates of freedom from all-cause mortality at 10, 30, and 50 days after weaning from ECMO were 75%, 55%, and 35% in the non-PCRTO group and 62%, 60%, and 58% in the PCRTO group, respectively (p=0.1). The incidence of cardiogenic shock after weaning from VA-ECMO was significantly higher in the non-PCRTO group (16% vs. 5%, p=0.04). In logistic regression analysis, PCRTO was a significant factor for survival to discharge (odds ratio, 2.42; 95% confidence interval, 1.29–5.28; p=0.02).
Conclusion: Compared to conventional methods, PCRTO is a feasible and reversible method, and it serves as a useful predictor of successful VA-ECMO weaning through a preload stress test.

Keywords: Extracorporeal membrane oxygenation, Weaning, Prognosis

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J Chest Surg

Published online April 8, 2024

Copyright © Journal of Chest Surgery.

Comparison of Conventional Methods with Pump-Controlled Retrograde Trial off for Weaning Adults with Cardiogenic Shock from Veno-Arterial Extracorporeal Membrane Oxygenation

Jeong-Jun Jo , M.D., Woo Sung Jang , M.D., Ph.D., Namhee Park , M.D., Ph.D., Yun Seok Kim , M.D., Ph.D., Jae Bum Kim , M.D., Kyungsub Song , M.D.

Department of Thoracic and Cardiovascular Surgery, Keimyung University Dongsan Hospital, Keimyung University College of Medicine, Daegu, Korea

Correspondence to:Kyungsub Song
Tel 82-53-258-4783
Fax 82-53-258-4783
E-mail chest.songks@gmail.com
ORCID
https://orcid.org/0000-0002-6556-2261

Received: December 1, 2023; Revised: January 20, 2024; Accepted: January 26, 2024

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: Pump-controlled retrograde trial off (PCRTO) is a safe, simple, and reversible method for weaning patients from veno-arterial extracorporeal membrane oxygenation (VA-ECMO). However, few studies have compared PCRTO to conventional weaning methods. This retrospective study aimed to compare PCRTO to non-PCRTO methods.
Methods: This study included patients who were weaned from VA-ECMO from January 2016 to December 2022 at our medical center. Demographic data, ECMO management, ECMO complications, survival to discharge, and cardiogenic shock after VA-ECMO weaning were compared between the 2 groups.
Results: Seventy patients who were weaned from VA-ECMO using PCRTO and 85 patients who were weaned with conventional methods were compared. Patient characteristics were not significantly different between the 2 groups. The rate of survival to discharge was significantly higher in the PCRTO group than in the non-PCRTO group (90% vs. 72%, p=0.01). The rates of freedom from all-cause mortality at 10, 30, and 50 days after weaning from ECMO were 75%, 55%, and 35% in the non-PCRTO group and 62%, 60%, and 58% in the PCRTO group, respectively (p=0.1). The incidence of cardiogenic shock after weaning from VA-ECMO was significantly higher in the non-PCRTO group (16% vs. 5%, p=0.04). In logistic regression analysis, PCRTO was a significant factor for survival to discharge (odds ratio, 2.42; 95% confidence interval, 1.29–5.28; p=0.02).
Conclusion: Compared to conventional methods, PCRTO is a feasible and reversible method, and it serves as a useful predictor of successful VA-ECMO weaning through a preload stress test.

Keywords: Extracorporeal membrane oxygenation, Weaning, Prognosis

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