Termination of extracorporeal membrane oxygenation for cardiac support

The determination of when to stop extracorporeal membrane oxygenation (ECMO ) rests upon demonstration of the return of adequate cardiac function to su pport vital organs and permit subsequent recovery. In general, patients wit h myocardial stun will recover function within several days. Factors that l imit recovery include elevated end diastolic pressures leading to marginal myocardial perfusion, ongoing organ damage, massive anasarca, or progressiv e deterioration in lung function. Following a trial of slow weaning of ECMO support to condition the heart to take over the entire system flow require ments, decannulation can be accomplished in a standard fashion. When weanin g is not successful and additional time does not lead to adequate recovery of cardiac function, physicians and nurses must be prepare to realistically advise families regarding such options as cardiac transplantation or withd rawal of support. It is critically important to provide an open and nonjudg mental environment for families to make these difficult decisions. The grea test difficulties involve ethical and emotional decisions that need to be m ade in a timely fashion to prevent undo burden on the patient when further ECMO support is futile.