ECMO-/ECLS

A. Strategies for weaning
 May stop infusions administered for <5 days
o Start WAT-1 scoring to monitor for withdrawal
 Wean any infusion administered for > 5 days
 Weaning for extubation
o Continuous infusions for 5-10 days
 If SBS less than target, then reduce morphine and
midazolam infusions by 50% and start WAT -1 scoring
o Continuous infusions for > 10 days
 If SBS less than target, reduce morphine and
midazolam by 25% and begin WAT -1 scoring
o Unable to wean due to safety or comfort issues
 Consider transitioning through extubation with propofol
or dexmedetomidine infusion
 After starting dexmedetomidine or propofol, wean
opioid and benzodiazepine by 25-50%
 Post extubation weaning
o SBS goal 0, max acceptable WAT-1 usually 4
o Opioid/benzodiazepine infusion:
 Wean infusion by 10-20% every 8 hours until off,
assuring WAT-1 <5