Weaning from VA #ECMO: which approach best reflects true cardiopulmonary reserve?? 🔄 PCRTO: retrograde flow through pump, creating controlled VA shunt mimicking native physiology (with regular #POCUS + invasive PAC monitoring), challenging RV + reducing LV afterload + enabling assessment of native lung function 🔍 pilot study: pump-controlled retrograde trial off feasibility, safety, physiological insights vs conventional weaning (reducing EBF to around 1 LPM, leaving residual RV unloading/LV afterload) 🫀 criteria for readiness-to-wean: resolution of underlying cause of CS, evidence of improving renal/hepatic perfusion, lactate  <  2 mmol/L, MAP  >  60 mmHg, pulse pressure  > 15 mmHg, improving LVOT VTI, absence of severe mitral or tricuspid regurgitation PCRTO appeared feasible, safe, informative complement to conventional weaning. In scenarios with advanced cardiac disease/borderline cases, its loading challenge added relevant information that impacted decision-making on short and long-term strategies ie - unmasking RV failure, biventricular compromise, respiratory deterioration prompting additional optimization - unmasking underlying defects enabling pre-explant repair - confirming stable haemodynamics/pulmonary function supporting safe weaning, avoiding premature escalation to durable #MCS @Crit_Care 🔓 rdcu.be/eJf91

Improving quality & outcomes of #ECMO in refractory cardiac arrest, Phoenix #ECPR project: 🔍retrospective analysis at @RBandH 2018-2023 ⚙️structured system including systematic screening process, strict exclusion criteria, assessment of resuscitation adequacy through physiological stop criteria, drilled/standardised cannulation process, post #resuscitation care + neuroprognostication introduced 🧠survival with good neurological outcomes significant higher after introduction of high-quality bundle of care prioritizing early identification, screening, activation & standardized care in #ECLS initiation & subsequent management. @BMJ_Open 🔓 bit.ly/4gsHpqz