Pump‐controlled retrograde trial off for weaning from venoarterial extracorporeal membrane oxygenation in an adult patient with pulmonary embolism

BACKGROUND: Although pump‐controlled retrograde trial off (PCRTO) is a practical method for weaning from venoarterial extracorporeal membrane oxygenation (VA‐ECMO), its advantages and safety for patients with pulmonary embolism are not yet reported. CASE PRESENTATION: A 62‐year‐old man with coronavirus disease 2019 experienced sudden cardiac arrest, and VA‐ECMO was introduced. After confirming a massive acute pulmonary embolism, unfractionated heparin treatment was initiated. On day 6, the patient was confirmed stable with a flow rate of 1.0 L/min. However, decannulation led to cardiac arrest and reintroduction of VA‐ECMO. After further treatment, a residual thrombus was observed, and pulmonary arterial pressure remained high. On day 23, ECMO was decannulated successfully after a weaning test with PCRTO, which simulated ECMO withdrawal by generating a partial arteriovenous shunt. CONCLUSION: PCRTO is a feasible weaning strategy and can be considered for patients with uncertain cardiorespiratory recovery.