Department of Adult Intensive Care, Queen Mary Hospital, Hong Kong, Hong Kong SAR.
Critical Care Medicine Unit, The University of Hong Kong, Hong Kong, Hong Kong SAR.
Artif Organs. 2023 Jun;47(6):1046-1058. doi: 10.1111/aor.14527. Epub 2023 Apr 3.
Various strategies of weaning V-A ECMO have been described. PCRTO is a weaning technique which involves serial decremental pump revolutions until a retrograde flow from the arterial to venous ECMO cannula is achieved. It has been reported as a feasible weaning strategy in the pediatric population, but its application in adults has not been widely reported.
This was a case series including all adult patients who underwent PCRTO during weaning from V-A ECMO at a tertiary ECMO center between January 2019 and July 2021. The primary end point was the successful weaning from V-A ECMO support.
A total of 57 runs of PCRTO in 36 patients were analyzed-45 (78.9%) of the trials were concluded successfully. The median retrograde blood flow rate during PCRTO was 0.6 ± 0.2 L/min, and the median duration of each PCRTO was 180 (120-240) min. Of the 35 patients who had at least one session of successful PCRTO, 31 (88.6%) were ultimately weaned from ECMO. There were no major complications from PCRTO including systemic or circuit thrombosis.
PCRTO is a feasible strategy for assessing readiness for weaning from V-A ECMO with a low risk of adverse events and high rate of predicting eventual successful ECMO decannulation. Further investigation including comparison with alternative weaning strategies in prospective studies is required to confirm the approach.
已经描述了各种 V-A ECMO 脱机策略。PCRTO 是一种脱机技术，它涉及到逐步降低泵的转速，直到从动脉 ECMO 插管到静脉 ECMO 插管出现逆行血流。它已被报道为儿科人群中可行的脱机策略，但在成人中的应用尚未广泛报道。
这是一项病例系列研究，包括 2019 年 1 月至 2021 年 7 月期间在一家三级 ECMO 中心接受 V-A ECMO 脱机期间进行 PCRTO 的所有成年患者。主要终点是成功从 V-A ECMO 支持中脱机。
共分析了 36 例患者 57 次 PCRTO 运行-45 次（78.9%）试验成功结束。PCRTO 期间的平均逆行血流率为 0.6±0.2L/min，每次 PCRTO 的中位持续时间为 180（120-240）min。在至少有一次成功 PCRTO 的 35 例患者中，31 例（88.6%）最终从 ECMO 脱机。PCRTO 没有发生重大并发症，包括全身或回路血栓形成。
PCRTO 是评估从 V-A ECMO 脱机准备情况的一种可行策略，不良事件风险低，预测最终 ECMO 拔管成功的可能性高。需要进一步的研究，包括在前瞻性研究中与替代脱机策略进行比较，以证实这种方法。
