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Intensive Care Medicine

, Volume 39, Issue 5, pp 838–846 | Cite as

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

  • 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 CombesEmail author
Original

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, FiO2ECMO (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 FiO2ECMO 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 FiO2ECMO 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.

Keywords

Extracorporeal membrane oxygenation Salvage therapy Shock Cardiogenic Outcome predictors Doppler echocardiography 

Supplementary material

134_2012_2785_MOESM1_ESM.doc (398 kb)
Supplementary material 1 (DOC 398 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2012

Authors and Affiliations

  • Matthieu Schmidt
    • 1
  • Guillaume Tachon
    • 1
  • Christine Devilliers
    • 2
  • Grégoire Muller
    • 1
  • Guillaume Hekimian
    • 1
  • Nicolas Bréchot
    • 1
  • Sybille Merceron
    • 1
  • Charles Edouard Luyt
    • 1
  • Jean-Louis Trouillet
    • 1
  • Jean Chastre
    • 1
  • Pascal Leprince
    • 3
  • Alain Combes
    • 1
    • 4
    Email author
  1. 1.Service de Réanimation Médicale, Groupe Hospitalier Pitié–SalpêtrièreInstitute of Cardiometabolism and Nutrition (iCAN), Assistance Publique-Hôpitaux de Paris–Université Pierre et Marie CurieParis 6France
  2. 2.Service de Biochimie, Hôpital de la Pitié–SalpêtrièreAssistance Publique-Hôpitaux de Paris–Université Pierre et Marie CurieParis 6France
  3. 3.Service de Chirurgie Cardiaque, Institut de Cardiologie, Hôpital de la Pitié–SalpêtrièreAssistance Publique-Hôpitaux de Paris–Université Pierre et Marie CurieParis 6France
  4. 4.Service de Réanimation Médicale, Hôpital de la Pitié–SalpêtrièreInstitute of Cardiometabolism and Nutrition (iCAN)Paris Cedex 13France

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