Extracorporeal membrane oxygenation (ECMO) is widely recognized as a life-saving measure. The use of veno-arterial extracorporeal membrane oxygenation (VA ECMO) is on the rise, serving as an effective mechanical circulatory support (MCS) device that aids in the restoration of systemic perfusion in patients suffering from cardiogenic shock. Weaning methods for VA ECMO exhibit considerable variability, with pump-controlled retrograde trial off (PCRTO) being one of the methods employed. PCRTO is a practical weaning method due to its physiological approach. In this case report, we discuss the application of PCRTO, in conjunction with a pulmonary artery catheter, for weaning a 41-year-old male patient from VA ECMO. The patient presented with acute coronary syndrome with cardiogenic shock. PCRTO played a pivotal role in the successful explantation of the ECMO cannulae, particularly given the patient’s uncertain cardiorespiratory recovery. The PCRTO method, being both feasible and reversible, serves as a significant predictor for successful weaning from VA ECMO through a preload stress test. This case underscores the potential of PCRTO as a valuable tool in the weaning process from VA ECMO.