Estimating cardiac output based on gas exchange during veno-arterial extracorporeal membrane oxygenation in a simulation study using paediatric oxygenators.

Bachmann, Kaspar Felix; Vasireddy, Rakesh; Heinisch, Paul Philipp; Jenni, Hansjörg; Vogt, Andreas; Berger, David (2021). Estimating cardiac output based on gas exchange during veno-arterial extracorporeal membrane oxygenation in a simulation study using paediatric oxygenators. Scientific reports, 11(1), p. 11528. Springer Nature 10.1038/s41598-021-90747-w

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Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) therapy is a rescue strategy for severe cardiopulmonary failure. The estimation of cardiac output during VA-ECMO is challenging. A lung circuit ([Formula: see text]Lung) and an ECMO circuit ([Formula: see text]ECMO) with oxygenators for CO2 removal ([Formula: see text]CO2) and O2 uptake ([Formula: see text]O2) simulated the setting of VA-ECMO with varying ventilation/perfusion ([Formula: see text]/[Formula: see text]) ratios and shunt. A metabolic chamber with a CO2/N2 blend simulated [Formula: see text]CO2 and [Formula: see text]O2. [Formula: see text] Lung was estimated with a modified Fick principle: [Formula: see text]Lung = [Formula: see text]ECMO × ([Formula: see text] CO2 or [Formula: see text]O2Lung)/([Formula: see text]CO2 or [Formula: see text]O2ECMO). A normalization procedure corrected [Formula: see text]CO2 values for a [Formula: see text]/[Formula: see text] of 1. Method agreement was evaluated by Bland-Altman analysis. Calculated [Formula: see text]Lung using gaseous [Formula: see text]CO2 and [Formula: see text]O2 correlated well with measured [Formula: see text]Lung with a bias of 103 ml/min [- 268 to 185] ml/min; Limits of Agreement: - 306 ml/min [- 241 to - 877 ml/min] to 512 ml/min [447 to 610 ml/min], r2 0.85 [0.79-0.88]). Blood measurements of [Formula: see text]CO2 showed an increased bias (- 260 ml/min [- 1503 to 982] ml/min), clinically not applicable. Shunt and [Formula: see text]/[Formula: see text] mismatch decreased the agreement of methods significantly. This in-vitro simulation shows that [Formula: see text]CO2 and [Formula: see text]O2 in steady-state conditions allow for clinically applicable calculations of [Formula: see text]Lung during VA-ECMO therapy.

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