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01-05-2013 | Original

Blood oxygenation and decarboxylation determinants during venovenous ECMO for respiratory failure in adults

Authors: Matthieu Schmidt, Guillaume Tachon, Christine Devilliers, Grégoire Muller, Guillaume Hekimian, Nicolas Bréchot, Sybille Merceron, Charles Edouard Luyt, Jean-Louis Trouillet, Jean Chastre, Pascal Leprince, Alain Combes

Published in: Intensive Care Medicine | Issue 5/2013

Abstract

Purpose

This study was designed to optimize the latest generation venovenous (vv)-extracorporeal membrane oxygenation (ECMO)-circuit configuration and settings based on the evaluation of blood oxygenation and CO₂ removal determinants in patients with severe acute respiratory distress syndrome (ARDS) on ultraprotective mechanical ventilation.

Methods

Blood gases and hemodynamic parameters were evaluated after changing one of three ECMO settings, namely, circuit blood flow, FiO_2ECMO (fraction of inspired oxygen in circuit), or sweep gas flow ventilating the membrane, while leaving the other two parameters at their maximum setting.

Results

Ten mechanically ventilated ARDS patients (mean age 44 ± 16 years; 6 males; mean hemoglobin 8.0 ± 1.8 g/dL) on ECMO for a mean of 9.0 ± 3.8 days) receiving femoro–jugular vv-ECMO were evaluated. vv-ECMO blood flow and FiO_2ECMO determined arterial oxygenation. Decreasing the ECMO flow from its baseline maximum value (5.8 ± 0.8 L/min) to 40 % less (2.4 ± 0.3 L/min) significantly decreased mean PaO₂ (arterial oxygen tension; 88 ± 24 to 45 ± 9 mm Hg; p < 0.001) and SaO₂ (oxygen saturation; 97 ± 2 to 82 ± 10 %; p < 0.001). When the ECMO flow/cardiac output was >60 %, SaO₂ was always >90 %. Alternatively, the rate of sweep gas flow through the membrane lung determined blood decarboxylation, while PaCO₂ (arterial carbon dioxide tension) was unaffected when the ECMO blood flow and FiO_2ECMO were reduced to <2.5 L/min and 40 %, respectively. In three additional patients evaluated before and after red blood cell transfusion, O₂ delivery increased after transfusion, allowing lower ECMO flows to reach adequate SaO₂.

Conclusions

For severe ARDS patients receiving femoro–jugular vv-ECMO, blood flow was the main determinant of arterial oxygenation, while CO₂ elimination depended on sweep gas flow through the oxygenator. An ECMO flow/cardiac output >60 % was constantly associated with adequate blood oxygenation and oxygen transport and delivery.

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Title: Blood oxygenation and decarboxylation determinants during venovenous ECMO for respiratory failure in adults
Authors: Matthieu Schmidt
Guillaume Tachon
Christine Devilliers
Grégoire Muller
Guillaume Hekimian
Nicolas Bréchot
Sybille Merceron
Charles Edouard Luyt
Jean-Louis Trouillet
Jean Chastre
Pascal Leprince
Alain Combes
Publication date: 01-05-2013
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 5/2013
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-012-2785-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Blood oxygenation and decarboxylation determinants during venovenous ECMO for respiratory failure in adults

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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