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
|
Text
2020 - Bachmann - AJPlung - PMID 32294391.pdf - Accepted Version Available under License Publisher holds Copyright. Download (6MB) | Preview |
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, 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: |
05 Dec 2022 15:38 |
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 |
Actions (login required)
 |
Edit item |