Safe and timely liberation from veno-venous extracorporeal membrane oxygenation (V-V ECMO) would be expected to reduce the duration of ECMO, the risk of complications, and costs. However, how to effectively liberate patients from V-V ECMO remains understudied.

What is the current state of the evidence on liberation from V-V ECMO?

We systematically searched for relevant publications on liberation from V-V ECMO in Medline and EMBASE. Citations were included if the manuscripts provided any of the following: criteria for readiness for liberation, a liberation protocol, and a definition of successful decannulation or decannulation failure. We included randomized trials, observational trials, narrative reviews, guidelines, editorials, and commentaries. We excluded single case reports and citations where full-text was unavailable.

We screened 1467 citations to identify 39 key publications on liberation from V-V ECMO. We then summarized the data into 5 main topics: current strategies used for liberation, criteria used to define readiness for liberation, conducting liberation trials, criteria used to proceed with decannulation, and parameters used to predict decannulation outcomes.

Practices on liberation from V-V ECMO are heterogeneous and strongly influenced by clinician preference. Additional research on liberation thresholds is needed to define optimal liberation strategies and close existing knowledge gaps in essential topics on liberation from V-V ECMO.