Implementing and Assessing a Standardized Protocol for Weaning Children Successfully From Extracorporeal Life Support

Area of Science:

• Pediatrics
• Cardiology
• Intensive Care Medicine

Background:

• Extracorporeal life support (ECLS) weaning lacks standardized guidelines, posing challenges for interdisciplinary teams.
• Assessing ventricular and pulmonary function, hemodynamics, and end-organ recovery during ECLS weaning is critical.

Purpose of the Study:

• To develop and assess the feasibility and efficacy of a standardized, stepwise protocol for ECLS weaning.
• To evaluate the protocol's impact on weaning success and patient outcomes.

Main Methods:

• A standardized, inter-professional, stepwise protocol for ECLS weaning was implemented in 2015.
• Weaning procedures were conducted bedside in the ICU, guided by echocardiography, involving flow reduction over 10-minute steps.
• Data were collected at baseline, during four weaning steps, and 30 minutes post-decannulation.

Main Results:

• The protocol was applied to 21 weaning procedures in 18 children (median age 177 days) requiring ECLS.
• The protocol-guided weaning success rate (≥24h survival) was 89%.
• The discharge home rate was 58%.

Conclusions:

• The novel standardized protocol facilitates ECLS weaning and improves its success rate.
• The protocol can be integrated into standard bedside ICU assessments.
• This approach aids in evaluating patient recovery during the weaning process.