Weaning and Decannulation

Over the past decade, ECMO support has seen exponential growth. There is, however, a paucity of evidence regarding weaning practices, and outcomes can differ between centers. In this chapter, we discuss the preconditions for weaning, management of patients’ sedation and mechanical ventilation during this phase, criteria for defining success or failure, and the optimal duration of a trial prior to decannulation. Moreover, there is no prospective evidence demonstrating the superiority of specific weaning protocolized steps over others; as a result, successfully weaning from ECMO, whether its VA or VV as a primary configuration, requires an understanding of the physiological interactions between the patient and the extracorporeal support system. When weaning the patient from extracorporeal support, it is crucial to monitor their physiological adaptations. Clinically, weaning is primarily driven by our understanding of physiology in the absence of evidence.