Deshpande Raghavendra, Rangappa Rajavardhan, Kanjilal Saikat, Moola Narayana Swamy, Kumar Suriyanathan Madhan
Department of Critical Care, Manipal Hospital Sarjapur Road, Bengaluru, 560102 India.
Department of Cardiology, Manipal Hospital Sarjapur Road, Bengaluru, 560102 India.
Indian J Thorac Cardiovasc Surg. 2025 Jul;41(7):937-941. doi: 10.1007/s12055-025-01895-x. Epub 2025 Feb 1.
Extracorporeal membrane oxygenation (ECMO) is widely recognized as a life-saving measure. The use of veno-arterial extracorporeal membrane oxygenation (VA ECMO) is on the rise, serving as an effective mechanical circulatory support (MCS) device that aids in the restoration of systemic perfusion in patients suffering from cardiogenic shock. Weaning methods for VA ECMO exhibit considerable variability, with pump-controlled retrograde trial off (PCRTO) being one of the methods employed. PCRTO is a practical weaning method due to its physiological approach. In this case report, we discuss the application of PCRTO, in conjunction with a pulmonary artery catheter, for weaning a 41-year-old male patient from VA ECMO. The patient presented with acute coronary syndrome with cardiogenic shock. PCRTO played a pivotal role in the successful explantation of the ECMO cannulae, particularly given the patient's uncertain cardiorespiratory recovery. The PCRTO method, being both feasible and reversible, serves as a significant predictor for successful weaning from VA ECMO through a preload stress test. This case underscores the potential of PCRTO as a valuable tool in the weaning process from VA ECMO.
The online version contains supplementary material available at 10.1007/s12055-025-01895-x.
体外膜肺氧合（ECMO）被广泛认为是一种挽救生命的措施。静脉-动脉体外膜肺氧合（VA ECMO）的使用正在增加，它作为一种有效的机械循环支持（MCS）设备，有助于恢复心源性休克患者的全身灌注。VA ECMO的撤机方法存在很大差异，泵控逆行试验撤机（PCRTO）是其中一种使用的方法。由于其生理方法，PCRTO是一种实用的撤机方法。在本病例报告中，我们讨论了结合肺动脉导管使用PCRTO为一名41岁男性患者撤离VA ECMO的情况。该患者表现为急性冠状动脉综合征并伴有心源性休克。PCRTO在成功拔除ECMO插管中起了关键作用，特别是考虑到患者心肺恢复情况不确定。PCRTO方法既可行又可逆，通过预负荷压力测试可作为从VA ECMO成功撤机的重要预测指标。本病例强调了PCRTO作为VA ECMO撤机过程中有价值工具的潜力。
在线版本包含可在10.1007/s12055-025-01895-x获取的补充材料。
