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Case Reports
. 2025 Sep;28(3):462-467.
doi: 10.1007/s10047-024-01484-6. Epub 2024 Dec 13.

ECMO-weaning facilitated by neurally adjusted ventilatory assist (NAVA): a case for principal clarification

F Heinold  1 , O Moerer  2 , L O Harnisch  2
Affiliations
Case Reports

ECMO-weaning facilitated by neurally adjusted ventilatory assist (NAVA): a case for principal clarification

F Heinold et al. J Artif Organs. 2025 Sep.

Abstract

The use of veno-venous extracorporeal membrane oxygenation (VV-ECMO) has become increasingly prevalent, particularly in respiratory disease pandemics such as H1N1-influenza and SARS-CoV-2. This surge has emphasized the importance of clear therapy recommendations, improved accessibility to ECMO technology, established ECMO teams, and structured networks to ensure access to specialized care throughout the course of the disease for patients with severe ARDS. Although the initiation criteria for VV-ECMO are well defined, treatment strategies while on ECMO regarding e.g., ventilator management or ECMO weaning strategies remain variable and with lack of consensus. NAVA (Neurally Adjusted Ventilatory Assist), as an assisted mechanical ventilation modality, offers real-time electromyographic feedback, which has been shown to enhance prolonged weaning processes from mechanical ventilation. We present a case of penetrating thoracic trauma complicated by ARDS, successfully managed with VV-ECMO. NAVA was employed to monitor and facilitate ECMO. This approach integrates ECMO weaning with ventilation settings, considering both gas exchange lung function, such as carbon dioxide removal, and respiratory mechanics in the form of neuromuscular coupling. This is a new approach to VV-ECMO weaning. More research is planned to validate the efficacy of this method in conjunction with additional parameters, such as diaphragm activity evaluated sonographically in a randomized design. This case underscores the potential of NAVA in VV-ECMO weaning, offering a promising avenue for optimizing patient care and outcomes.

Keywords: Extracorporeal life support (ECLS); Neurally Adjusted Ventilatory Assist (NAVA); Thoracic emergencies; Veno-venous extracorporeal membrane oxygenation (vv-ECMO).

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Conflict of interest statement

Declarations. Conflict of interest: FH reports that there are no conflicts of interest. LOH received honoraria for educational lectures from CSL Behring, Baxter, and Shionogi, honoraria from a book project published in 2023 (Springer Book on neuro-monitoring in the ICU Book: Neuromonitoring in der Intensivmedizin 2023, ISBN: 978-3-662-65997-7), and an unrestricted research grant from Sartorius AG Göttingen. OM is a member of the national CEOsys network Germany (Covid Ecosystem), and the Napkon-Tip (Therapeutic intervention platform for conducting ongoing assessments of new therapies), funded by the Federal Ministry of Education and Research (BMBF). Holds a research grant from Advitos for conducting experimental studies related to extracorporeal multiorgan support. OM received honoraria from a book project published in 2023. Springer Book on neuro-monitoring in the ICU Book: Neuromonitoring in der Intensivmedizin 2023, ISBN: 978-3-662-65997-7. Within the last 36 months OM received honoraria for industry sponsored lectures on congresses by Getinge (hemodynamic monitoring) and CSL Behring (coagulation). The Department of Anesthesiology holds courses and workshops supported by companies related to intensive care medicine.

Figures

Fig. 1
Fig. 1
Chest radiography upon ICU admission, with two indwelling left sided chest drains in place, in the presence of persistent left sided pneumo- and hemothorax
Fig. 2
Fig. 2
Chest radiography following ECMO and Tracheostomy tube placement in ARDS
Fig. 3
Fig. 3
a before gas flow break b after gas flow break
See this image and copyright information in PMC

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