End-Tidal Carbon Dioxide Concentration Can Estimate the Appropriate Timing for Weaning Off From Extracorporeal Membrane Oxygenation for Refractory Circulatory Failure

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Although extracorporeal membrane oxygenation (ECMO) is widely used as temporary circulation support, there are no reports of direct parameters indicating cardiac recovery to determine the timing of weaning off.Twenty-five patients supported by ECMO due to hemodynamic deterioration were divided into 2 groups according to their outcome: weaned ECMO (W: n = 18) or not (NW: n = 7). In the W group, we examined the differences in parameters between the 2 time points, ECMO introduction, and the reduction in ECMO flow to 40% of the initial setting known as the conventional recovery point (C-point). Significant differences were observed in systolic pulmonary artery pressure, the cardiac index measured by the thermodilution method, C-reactive protein, lactate, base excess, and the end-tidal CO2 concentration (ETCO2). Next, by closely examining these 6 parameters measured every 12 hours, we found that only ETCO2 had always changed steeply, like a ‘flexion point’ (E-point), in all W cases, but not in NW. The E-point was defined as an initial increase in ETCO2 of ≥ 5 mmHg over the preceding 12 hours with a continued rise over the next 12 hours. E-points appeared as much as 95 ± 60 hours earlier than C-points and also preceded weaning off of ECMO.ETCO2 can be a useful continuous parameter for predicting the adequate timing of weaning off of ECMO for circulatory failure at the bedside.