P92: Arterio-Venous Bridge for Peripheral Veno-Arterial Extracorporeal Membrane Oxygenation Weaning in Adults

Abstract

Background: The timing for liberation of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) can be challenging. Various ECMO weaning strategies have been described in the literature. Arterio-venous (AV) bridge has been deployed successfully in the pediatric population but remains underutilized in adults. This case study illustrates the usefulness of AV bridge technique in adult VA-ECMO weaning trial. Method: Arterio-venous bridge is a weaning modality that allows the patient to be temporarily fully removed from VA-ECMO therapy while maintaining the ECMO circuit integrity and enabling the immediate resumption of ECMO therapy. The technique of AV bridge is described in Picture 1 and clinical data, including diagnosis, hemodynamics, biomarkers, are included in Table 1. We present two cases of adult VA-ECMO weaning trial utilizing AV bridge. Result: One patient who had previously undergone a failed VA-ECMO weaning trial initially was subsequently weaned and successfully decannulated utilizing the AV bridge technique. The second patient was able to tolerate AV bridge off pump trial up for two hours but became hypoxic and acidotic, and eventually placed back on VA-ECMO. With no evidence of recovery and poor candidacy for advanced therapies, patients was transitioned to comfort care. Conclusion: Arterio-venous bridge is a safe and effective method to wean from VA-ECMO in adult patients. It not only allows clinicians to monitor patient’s hemodynamics when patient is fully off VA-ECMO support, but also retains the capability of immediate therapy resumption if patient fails the wean.Figure 1. The technique of AV bridge Table 1. - Patients’ Characteristics, Hemodynamics and Biomarkers when off ECMO Patient Diagnosis Hemodynamics Biomarkers Pressor Requirement MAP CVP PA Lactate PaO2 PaCO2 58 yo M Hemorrhagic Shock s/p OHT 71 12 34/25 =0.9 111 38 = 60 yo F Cardiogenic shock 2/2 CTEPH 70 10 88/49 ↑2.9 57 55 ↑↑↑