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Critical Care
Published in: Critical Care 1/2019

Open Access 01-12-2019 | Metabolic Acidosis | Letter

How to treat combined respiratory and metabolic acidosis after extracorporeal cardiopulmonary resuscitation?

Authors: Xavier Bemtgen, Florentine Schroth, Tobias Wengenmayer, Paul M. Biever, Daniel Duerschmied, Christoph Benk, Christoph Bode, Dawid L. Staudacher

Published in: Critical Care | Issue 1/2019

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Excerpt

Establishing a venoarterial extracorporeal membrane oxygenation (vaECMO) in cardiac arrest is known as extracorporeal cardiopulmonary resuscitation (eCPR). After eCPR, patients commonly present with a combined respiratory and metabolic acidosis [1]. It is clear that acidosis negatively impacts survival after eCPR [2] and that a respiratory acidosis can be easily corrected by vaECMO. Current guidelines for conventional CPR suggest normocapnia as targeted after return of spontaneous circulation [3]. This recommendation is based on heterogeneous data. While a recent meta-analysis found adverse outcome in both hyper- and hypocapnia [4], a randomized trial reported no difference in survival in low normal and high normal paCO2 [5]. …
Literature
1.
Le Guen M, Nicolas-Robin A, Carreira S, Raux M, Leprince P, Riou B, et al. Extracorporeal life support following out-of-hospital refractory cardiac arrest. Crit Care. 2011;15:R29.CrossRef
2.
Debaty G, Babaz V, Durand M, Gaide-Chevronnay L, Fournel E, Blancher M, et al. Prognostic factors for extracorporeal cardiopulmonary resuscitation recipients following out-of-hospital refractory cardiac arrest. A systematic review and meta-analysis. Resuscitation. 2017;112:1–10.CrossRef
3.
Callaway CW, Donnino MW, Fink EL, Geocadin RG, Golan E, Kern KB, et al. Part 8: post–cardiac arrest care. Circulation. 2015;132:S465–82.CrossRef
4.
McKenzie N, Williams TA, Tohira H, Ho KM, Finn J. A systematic review and meta-analysis of the association between arterial carbon dioxide tension and outcomes after cardiac arrest. Resuscitation. 2017;111:116–26.CrossRef
5.
Jakkula P, Reinikainen M, Hästbacka J, Loisa P, Tiainen M, Pettilä V, et al. Targeting two different levels of both arterial carbon dioxide and arterial oxygen after cardiac arrest and resuscitation: a randomised pilot trial. Intensive Care Med. 2018;44:2112–21.CrossRef
Metadata
Title
How to treat combined respiratory and metabolic acidosis after extracorporeal cardiopulmonary resuscitation?
Authors
Xavier Bemtgen
Florentine Schroth
Tobias Wengenmayer
Paul M. Biever
Daniel Duerschmied
Christoph Benk
Christoph Bode
Dawid L. Staudacher
Publication date
01-12-2019
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2019
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-019-2461-2

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