Coming Off of ECMO
The ECMO team will evaluate the patient every day and watch for any improvements. Blood tests and vital signs are just a couple of examples of the factors that will be used to decide if your loved one is getting better. When he or she gets to a point where very little help is needed from the ECMO machine, the team will do a "weaning trial". This is done differently based on whether the patient is on VA or VV ECMO. But, the "weaning trial" gives the ECMO team a good indication of how you're your loved one will do without ECMO support. The cannulas will remain in place throughout the "minimal support" period, and will only be removed once the entire healthcare team is confident that your loved one will do well without help from the ECMO machine.
Even with the ECMO team's best efforts, there is a chance that your loved one may not get better after being on ECMO. The team will talk with you on a daily basis about how he or she is doing. If the time comes where the ECMO doctors feel that everything possible has been done to help your loved, but he or she is not getting better, or is maybe even getting worse, your loved one's health care team, including the intensivist and ECMO doctor, will discuss the next options with you fully at a family conference.
What to Expect After ECMO
If and when the decision is made to take your loved off of ECMO, the surgeon will return to take out the cannulas. This requires an operation, which will typically be done at the bedside in the Intensive Care Unit for VV ECMO and in the operating room for VA ECMO. Stitches and dressings will be placed to prevent bleeding from the cannula sites once they are removed.
Until the patient is able to breathe on his/her own, he or she will remain on the ventilator. Little by little, your loved one's lungs should improve, and the ICU team will be able to decrease the settings on the breathing machine. Once the settings are very low and the patient is doing all of the work of breathing on his or her own, the ventilator will be removed.
Once your loved one is off of ECMO and off of the ventilator, there may still a lot work to be done before going home. He or she must have stable (good) vital signs and be able to eat without difficulty. It may take time to eat on his/her own and swallow effectively, and a feeding tube may be needed until this goal is reached. It may also take several days to weeks for your loved one to get back to a normal routine since being in bed for such a long time can make them very weak, and it will take time to build their muscles back up. Speech therapy, physical therapy, social work, and case management are all resources available to help the patient and family at this point in recovery. The ECMO team will also continue to follow your loved one's progress and are available as a resource before going home.