Update on the management and associated challenges of adult patients treated with veno-arterial extracorporeal membrane oxygenation

INTRODUCTION: Currently, veno-arterial extracorporeal membrane oxygenation (VA ECMO) represents a valuable treatment option for patients presenting with severe cardiogenic shock. Although the overall usage of VA ECMO in experienced centers is expanding, some management aspects remain challenging, with no consensus among centers on well-defined assessment criteria, duration, and, particularly, weaning strategies. AREAS COVERED: This article aims to provide a review and evaluation of strategies reported in the literature to wean patients from VA ECMO, with a special emphasis on weaning protocols. A selected successful weaning protocol and rate of removal of adult patients from VA ECMO from recent reports will be also discussed. EXPERT COMMENTARY: To improve patient outcome, it is essential to remove patients from VA ECMO without weaning failure. Furthermore, the accurate evaluation of the patient's condition must be principal. However, as technology advances, the strategy of weaning patients from VA ECMO or drug therapies is changing, and we must periodically update our knowledge and use of VA ECMO.