ECLS circuit or intravenous anesthesia with narcotics, benzodiazepines and
paralytics may be employed. Procedures on ELCS include recannulation or
repositioning of the cannulas, tube thoracostomy, cardiac surgery or
catheterization, repair of congenital diaphragmatic hernia, and thoracotomy for
bleeding, effusion or lung biopsy.[ 22 , 23 ] Hemorrhagic complications, which
occurred in almost half the patients, were associated with a higher mortality;
therefore, only procedures that are absolutely necessary should be performed
while on ECLS and others delayed until ECLS can be discontinued. During all
procedures on ECLS, electrocautery should be used generously, the ACT
reduced to approximately 160-180 seconds, platelet count maintained well above
100,000/mm^3 , and the perioperative administration of aminocaproic acid should
be highly considered.[ 5 ]
D. Weaning and Decannulation
Over the ensuing days on ECLS, as the cardiopulmonary pathology
resolves, the inflammatory process subsides, the pulmonary radiographic
appearance improves, and the elevated pulmonary vascular pressures
normalize, gas exchange increases across the native lung.[ 5 ] The ECLS flow
rate is weaned as gas exchange improves based on the SvO 2. Simultaneous
increases in lung compliance are frequently observed.[ 24 ] Most practitioners
transiently discontinue extracorporeal support in order to determine the true
cardiopulmonary function; this “trial off” is performed during VA bypass by
clamping the arterial and venous connectors between the bridge and the patient