Perform a stepwise reduction of ECMO flow by 500-1000 mL every five (5) to 15 minutes until reaching a total ECMO flow of 1.0 L/min with monitoring.

• Sweep should not be reduced lower than 0.5 L/min.
  • Do not shut off sweep when weaning VA ECMO. This creates a shunt.
• Hemodynamic and echocardiography (transthoracic or transesophageal) measures should be obtained at multiple levels of reduced ECMO flow