The Effects of Vasoconstriction and Volume Expansion on Veno-Arterial ECMO Flow.

Werner Möller, Per; Hana, Anisa; Heinisch, Paul Philipp; Liu, Shengchen; Djafarzadeh, Siamak; Hänggi, Matthias; Bloch, Andreas; Takala, Jukka; Jakob, Stephan; Berger, David (2018). The Effects of Vasoconstriction and Volume Expansion on Veno-Arterial ECMO Flow. (In Press). Shock Lippincott Williams & Wilkins 10.1097/SHK.0000000000001197

[img] Text
2018 - Moller - Shock - PMID 29877960.pdf - Accepted Version
Restricted to registered users only until 1 July 2019.
Available under License Publisher holds Copyright.

Download (1MB) | Request a copy

BACKGROUND Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is gaining widespread use in the treatment of severe cardiorespiratory failure. Blood volume expansion is commonly used to increase ECMO flow (QECMO), with risk of positive fluid balance and worsening prognosis. We studied the effects of vasoconstriction on recruitment of blood volume as an alternative for increasing QECMO, based on the concepts of venous return. METHODS In a closed chest, centrally cannulated porcine preparation (n = 9) in ventricular fibrillation and VA-ECMO with vented left atrium, mean systemic filling pressure (MSFP) and venous return driving pressure (VRdP) were determined in Euvolemia, during Vasoconstriction (norepinephrine 0.05, 0.125 and 0.2 μg/kg/min) and following Volume Expansion (3 boluses of 10 mL/kg Ringer's lactate). Maximum achievable QECMO was examined. RESULTS Vasoconstriction and Volume Expansion both increased maximum achievable QECMO, delivery of oxygen (DO2) and MSFP, but right atrial pressure increased in parallel. VRdP did not change. The vascular elastance curve was shifted to the left by Vasoconstriction, with recruitment of stressed volume. It was shifted to the right by Volume Expansion with direct expansion of stressed volume. Volume Expansion decreased resistance to venous return and pump afterload. CONCLUSIONS In a circulation completely dependent on ECMO support, maximum achievable flow directly depended on the vascular factors governing venous return - i.e. closing conditions, stressed vascular volume and the elastance and resistive properties of the vasculature. Both treatments increased maximum achievable ECMO flow at stable DO2, via increases in stressed volume by different mechanisms. Vascular resistance and pump afterload decreased with Volume Expansion.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic of Intensive Care

UniBE Contributor:

Werner Möller, Per; Hana, Anisa; Heinisch, Paul Philipp; Liu, Shengchen; Djafarzadeh, Siamak; Hänggi, Matthias; Bloch, Andreas; Takala, Jukka; Jakob, Stephan and Berger, David

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1073-2322

Publisher:

Lippincott Williams & Wilkins

Language:

English

Submitter:

Mirella Aeberhard

Date Deposited:

15 Jun 2018 11:20

Last Modified:

15 Jun 2018 11:20

Publisher DOI:

10.1097/SHK.0000000000001197

PubMed ID:

29877960

BORIS DOI:

10.7892/boris.117216

URI:

https://boris.unibe.ch/id/eprint/117216

Actions (login required)

Edit item Edit item
Provide Feedback