Venoarterial extracorporeal membrane oxygenation may be used for circulatory support in cardiogenic shock as a bridge to recovery, a bridge to a ventricular assist device (VAD), or a bridge to transplant. While the determination of potential exit strategies is essential before cannulation, the final determination of a patient’s options may change, in part, through their in-hospital clinical course. We propose that liberation from venoarterial extracorporeal membrane oxygenation should be conceptualized as a process of discovery in the assessment of a patient’s underlying clinical status and a key driver of further clinical decision-making. A trial of liberation from support should be considered when the goals of the weaning trial are well-defined and, ideally, in the absence of potentially confounding clinical factors. In this review, we will discuss readiness to wean criteria from venoarterial extracorporeal membrane oxygenation, as well as specific clinical, biochemical, and echocardiographic parameters that may prove useful in determining weaning timing and revealing the patient’s underlying hemodynamic status and prognosis. The role of various cannula configurations, support devices, and pharmacological adjuncts will also be discussed. Finally, we highlight current gaps in evidence and suggest areas of future research.

中文翻译：

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从静脉动脉体外膜氧合中解放出来：综述

静脉动脉体外膜氧合可用于心源性休克中的循环支持，作为恢复的桥梁、心室辅助装置 (VAD) 的桥梁或移植的桥梁。虽然在插管之前确定潜在的退出策略是必不可少的，但最终确定患者的选择可能会部分地通过他们的住院临床过程而改变。我们建议从静脉动脉体外膜氧合中解放出来应该被概念化为评估患者潜在临床状态的发现过程和进一步临床决策的关键驱动因素。当脱机试验的目标明确且理想情况下不存在潜在的混杂临床因素时，应考虑从支持中解放试验。在本次审查中，我们将讨论从静脉动脉体外膜肺氧合中撤机的准备情况，以及特定的临床、生化和超声心动图参数，这些参数可能有助于确定撤机时间和揭示患者的潜在血流动力学状态和预后。还将讨论各种套管配置、支持装置和药理学辅助剂的作用。最后，我们强调了当前的证据差距，并提出了未来研究的领域。和药理学辅助剂也将被讨论。最后，我们强调了当前的证据差距，并提出了未来研究的领域。和药理学辅助剂也将被讨论。最后，我们强调了当前的证据差距，并提出了未来研究的领域。