Pulmonary artery flotation catheter (PAFC) combined with pump-controlled retrograde trial off (PCRTO) as a trial for weaning VA-ECMO patients: A retrospective study.

Abstract

Pump-controlled retrograde trial off (PCRTO) has been recently proposed as an effective and safe VA-ECMO weaning method. However, reports of haemodynamic monitoring during PCRTO are rare. Therefore, the purpose of this study was to investigate the changes in the left and right heart function during the PCRTO process combined with a pulmonary artery flotation catheter (PAFC). Between March 2019 and May 2021, 20 adult VA-ECMO patients who underwent PCRTO in combination with PAFC were enrolled in this study. The patients' general characteristics, PCRTO results, haemodynamic parameters during PCRTO progression, complications, and clinical prognoses were analysed. Those who survived for 48h after withdrawal and did not require ECMO assistance were defined as the success group, and those who did not survive for 48h after withdrawal or who required ECMO assistance were defined as the failure group. Of the 20 patients, 13 (65%) were included in the success group, and 7 (35%) were included in the failure group. Compared with the success group, the heart rate (HR) of the failure group was significantly increased 30 min after PCRTO (p < .01), and the pulmonary artery wedge pressure (PAWP) was significantly higher at all time points (p < .01). Compared with pre-PCRTO in the success group, the HR at 2min in the success group was significantly increased, but decreased to the baseline levels at 15min and 30min. The PAWP was also significantly increased at 2min, but decreased at 15min and dropped to the baseline level at 30min in the success group. Compared with pre-PCRTO in the failure group, the HR and PAWP increased significantly at 2min, 15min and 30min in the failure group. No new embolism-related complications were found in the success group after the withdrawal from ECMO. PCRTO is a safe and reliable VA-ECMO weaning method. Combined with haemodynamic monitoring through PAFC, PCRTO can better assess the cardiac reserve function.