Tom Ferry: ECMO Weaning Begins at the Circuit, Not the Bedside
Tom Ferry, Central Coast Perfusion LLC of Founding President, shared a post on LinkedIn:
“Most ECMO weaning trials fail at the circuit — not the bedside.
Here’s what the guidelines say, and what they leave to us.
ELSO is clear on the framework for VV ECMO:
reduce flow, assess gas exchange reserve, trial off sweep.
For VA, the stepwise approach is well established — reduce flow by 1 L/min, assess 5–10 minutes at each step, don’t go below 0.5 L/min except in exceptional circumstances.
What the guidelines don’t tell you is who’s managing the circuit during that window.
When flow drops, everything changes.
- Flow – stasis risk
- Flow – altered pressure gradients across the membrane
- Flow – recirculation dynamics shift in VV configurations
- Flow – anticoagulation targets established at full support deserve reassessment as flows drop
The perfusionist isn’t just watching a number go down.
We’re watching sweep gas, circuit pressures, and the first signs of fibrin deposition that the bedside team is too focused on the echo to catch.
ELSO recommends reducing VV flow to 1–1.5 LPM to assess oxygenation reserve during a weaning trial.
At those flows, your circuit is vulnerable.
That’s not the moment to have a passive observer at the console.
The weaning trial is a team event.
The circuit management during that trial is a perfusion event.
If your ECMO program doesn’t have a clearly defined perfusionist role during formal weaning studies — that’s a protocol gap worth closing.
What does your program’s weaning protocol look like?”
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