The decision to end ECLS (extracorporeal life support) is one made by the team as group. When a patient is first placed on ECMO, the pump flow is high and the ECMO machine is doing most of the work of the heart and lungs. The cardiac medications and ventilator can be turned down to allow the heart and lungs to rest. When the patient shows improvement, the ECMO machine can be turned down and medications and ventilation can be slowly increased to help the patient support his/her own heart and lungs.
Once at “low flow,” or idling, the patient can be taken off ECMO for a “wean,” during which the patient is assessed to determine whether he/she is ready to come off ECMO. If the patient appears to do well during the trial off ECMO, then the surgeon will remove the cannulas. However, if there are problems – and this is not uncommon – the patient can go back on ECMO for a few more days. Other options for ending ECMO are to transition to longer-term devices such as a ventricular assist device (VAD) or to organ transplantation.
There are times when a patient is deteriorating and it becomes clear that the ECMO treatment is not helping the patient achieve his/her care goals. Usually, this will be in the setting of several discussions with the family indicating that things are getting worse rather than stabilizing or improving. Under this circumstance, ECMO will be stopped and, in most cases, the patient will pass. The entire medical team, including palliative care specialists, social workers and chaplains, are always available to assist during these difficult times.
For assistance in facilitating transfers to Ronald Reagan UCLA Medical Center, contact the UCLA Health Transfer Center at 310-825-0909