Gas exchange calculation may estimate changes in pulmonary blood flow during veno-arterial extracorporeal membrane oxygenation in a porcine model.

Bachmann, Kaspar Felix; Haenggi, Matthias; Jakob, Stephan M.; Takala, Jukka; Gattinoni, Luciano; Berger, David (2020). Gas exchange calculation may estimate changes in pulmonary blood flow during veno-arterial extracorporeal membrane oxygenation in a porcine model. American journal of physiology - lung cellular and molecular physiology, 318(6), L1211-L1221. American Physiological Society 10.1152/ajplung.00167.2019

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BACKGROUND

Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is used as rescue for severe cardiopulmonary failure. We tested whether the ratio of CO2 elimination at the lung and the ECMO (VCO2ECMO/VCO2Lung) would reflect the ratio of respective blood flows and could be used to estimate changes in pulmonary blood flow (QLUNG), i. e. native cardiac output.

METHODS

Four healthy pigs were centrally cannulated for VA-ECMO. We measured blood flows with an ultrasonic flow probes. VCO2ECMO and VCO2Lung were calculated from sidestream capnographs under constant pulmonary ventilation during ECMO weaning with changing sweep gas and/or ECMO blood flow. If ventilation/perfusion (V/Q) ratio of ECMO was not one, the VCO2ECMO was normalized to V/Q=1 (VCO2ECMONORM). Changes in pulmonary blood flow were calculated using the relationship between changes in CO2 elimination and ECMO blood flow.

RESULTS

QECMO correlated strongly with VCO2ECMONORM (r2 0.95 - 0.99). QLUNG correlated well with VCO2LUNG (r2 0.65 - 0.89, p<=0.002). Absolute QLung could not be calculated in a non-steady state. Calculated pulmonary blood flow changes had a bias of 76 (-266 to 418) ml/min and correlated with measured QLUNG (r2 0.974 - 1.000, p = 0.1 to 0.006) for cumulative ECMO flow reductions.

CONCLUSIONS

VCO2 of the lung correlated strongly with pulmonary blood flow. Our model could predict pulmonary blood flow changes within clinically acceptable margins of error. The prediction is made possible with a normalization to a V/Q of 1 for ECMO. This approach depends on measurements readily available and may allow immediate assessment of the cardiac output response.

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

UniBE Contributor:

Bachmann, Kaspar; Hänggi, Matthias; Jakob, Stephan; Takala, Jukka and Berger, David

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1040-0605

Publisher:

American Physiological Society

Language:

English

Submitter:

Mirella Aeberhard

Date Deposited:

23 Apr 2020 14:30

Last Modified:

16 Apr 2021 02:30

Publisher DOI:

10.1152/ajplung.00167.2019

PubMed ID:

32294391

Uncontrolled Keywords:

Carbon Dioxide Cardiac Output ECMO Intensive Care Weaning

BORIS DOI:

10.7892/boris.143412

URI:

https://boris.unibe.ch/id/eprint/143412

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