What is the first step in the decannulation process on VV ECMO?

In the decannulation process on venovenous (VV) ECMO, the correct first step involves the returning blood while placing sutures. This step ensures that the patient's hemodynamics are maintained as the cannula is being removed. While the ECMO support is being withdrawn, continuous blood return helps avoid any sudden drops in blood volume or pressure, which could compromise the patient’s stability.

This action is critical because it acts as a transitional phase where the patient begins to be weaned from ECMO support while still receiving adequate perfusion. This careful management helps in monitoring the patient closely for any signs of instability that may arise during the decannulation procedure.

On the contrary, pulling the cannula directly or clamping the ECMO circuit may lead to adverse events if not managed correctly. Additionally, monitoring the patient for stability is an essential step but it typically follows the initial actions of returning blood and securing sutures, as it is part of ongoing patient assessment rather than the first procedural step.