Introduction: The standard ECMO circuit has a bridge between the venous drainage and infusion tubing. This allows temporary dissociation of the patient from the ECLS circuit. Traditionally, while weaning from ECMO, pump and patient flows are not reduced below 100 ml/min for newborn and kept much higher in older children to prevent clotting in the circuit and the membrane oxygenator. These low flows during weaning may represent more than a third of the patient's cardiac output. Trialing off of the patients from ECMO at these flows may fail. We have used an open-bridge technique to maintain high pump flows through the circuit and were able to reduce the patient flows to much lower rates and achieved a more stable and successful rate of decannulation. We are reporting the successful clinical application of partially opened bridge ECMO for weaning.

Methods: We have reviewed the medical records of the children who received ECMO in the Pediatric Intensive Care Unit and weaned with open-bridge ECMO. Demographic data, type of ECMO, lowest flow rates while weaning, duration of ECMO and duration of open-bridge ECMO were collected. The bridge was kept partially opened with the help of a modified Hoffman clamp.

Results: No complications related to partially opening the bridge during ECMO were noted. All (eight) patients were successfully decannulated using this technique. Data are shown below.

Conclusions: The open-bridge ECMO technique helps to wean patients safely from ECMO. It enables to reduce the patient flow rates to much lower than standard “idle” flows, while maintaining the blood flow through the circuit at higher rates. We recommend the open-bridge ECMO technique during weaning from ECMO for complex patients. Table

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