Matsumura Kazuki, Shimizu Keiki, Horikoshi Yuichi, Hamaguchi Jun, Matsuyoshi Takeo, Sasaki Junichi
ECMO Center, Department of Emergency and Critical Care Medicine, Tokyo Metropolitan Tama Medical Center, Fuchu, Japan.
Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Shinjuku, Japan.
Perfusion. 2025 Apr;40(3):782-786. doi: 10.1177/02676591241258689. Epub 2024 May 29.
IntroductionPump-controlled retrograde trial off (PCRTO) is described as an effective weaning strategy for veno-arterial extracorporeal membrane oxygenation (ECMO) in the guidelines. Contrastingly, there is no established weaning strategy for veno-arteriovenous (V-AV) ECMO. We report a novel application of PCRTO in a patient undergoing V-AV ECMO.Case reportA 49-year-old man had pneumonia and a history of kidney transplantation. Two days after intubation, respiratory failure progressed and veno-venous (V-V) ECMO was introduced. On day 7 after ECMO, the configuration was changed to V-AV ECMO owing to septic cardiomyopathy due to suspected cholangitis. On day 15, with partial haemodynamic improvement and persistent respiratory failure, PCRTO was performed; the patient was safely returned to V-V ECMO.DiscussionIn patients undergoing V-AV ECMO, PCRTO could have the potential to accurately simulate decannulation of the arterial cannula.ConclusionThis novel weaning strategy could be considered in patients undergoing V-AV ECMO.
引言
指南中将泵控逆行试验关闭（PCRTO）描述为静脉-动脉体外膜肺氧合（ECMO）的一种有效撤机策略。相比之下，静脉-动脉-静脉（V-AV）ECMO尚无既定的撤机策略。我们报告了PCRTO在一名接受V-AV ECMO治疗的患者中的新应用。
病例报告
一名49岁男性患有肺炎且有肾移植史。插管两天后，呼吸衰竭进展，遂采用静脉-静脉（V-V）ECMO。在ECMO治疗的第7天，由于疑似胆管炎导致感染性心肌病，装置配置改为V-AV ECMO。在第15天，患者血流动力学部分改善但仍存在持续呼吸衰竭，遂进行PCRTO；患者安全转回V-V ECMO。
讨论
在接受V-AV ECMO治疗的患者中，PCRTO有可能准确模拟动脉插管拔除。
结论
对于接受V-AV ECMO治疗的患者，可考虑采用这种新的撤机策略。
