Physiologic Effects of ECMO in Patients with Severe Acute Respiratory Distress Syndrome
RATIONALE: Blood flow rate affects mixed venous oxygenation (SvO2) during venovenous extracorporeal membrane oxygenation (ECMO), with possible effects on the pulmonary circulation and the right heart function.
OBJECTIVES: We aimed at describing the physiologic effects of different levels of SvO2 obtained by changing ECMO blood flow, in patients with severe ARDS receiving ECMO and controlled mechanical ventilation.
METHODS: Low (SvO2 target 70-75%), intermediate (SvO2 target 75-80%) and high (SvO2 target > 80%) ECMO blood flows were applied for 30 minutes in random order in 20 patients. Mechanical ventilation settings were left unchanged. The hemodynamic and pulmonary effects were assessed with pulmonary artery catheter and electrical impedance tomography (EIT).
MEASUREMENTS AND MAIN RESULTS: Cardiac output decreased from low to intermediate and to high blood flow/SvO2 (9.2 [6.2-10.9] vs 8.3 [5.9-9.8] vs 7.9 [6.5-9.1] L/min, p = 0.014), as well as mean pulmonary artery pressure (34 ± 6 vs 31 ± 6 vs 30 ± 5 mmHg, p < 0.001), and right ventricle stroke work index (14.2 ± 4.4 vs 12.2 ± 3.6 vs 11.4 ± 3.2 g*m/beat/m2, p = 0.002). Cardiac output was inversely correlated with mixed venous and arterial PO2 values (R2 = 0.257, p = 0.031 and R2 = 0.324, p = 0.05). Pulmonary artery pressure was correlated with decreasing mixed venous PO2 (R2 = 0.29, p <0.001) and with increasing cardiac output (R2 = 0.378 p < 0.007). Measures of ventilation/perfusion mismatch did not differ between the three steps.
CONCLUSIONS: In severe ARDS patients, increased ECMO blood flow rate resulting in higher SvO2 decreases pulmonary artery pressure, cardiac output, and right heart workload. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/).
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - year:2024 |
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| Enthalten in: |
American journal of respiratory and critical care medicine - (2024) vom: 25. März |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Spinelli, Elena [VerfasserIn] |
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| Links: |
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| Themen: |
Blood flow |
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| Anmerkungen: |
Date Revised 17.04.2024 published: Print-Electronic Citation Status Publisher |
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| doi: |
10.1164/rccm.202309-1688OC |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM370160541 |
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| 100 | 1 | |a Spinelli, Elena |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Physiologic Effects of ECMO in Patients with Severe Acute Respiratory Distress Syndrome |
| 264 | 1 | |c 2024 | |
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| 500 | |a Date Revised 17.04.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status Publisher | ||
| 520 | |a RATIONALE: Blood flow rate affects mixed venous oxygenation (SvO2) during venovenous extracorporeal membrane oxygenation (ECMO), with possible effects on the pulmonary circulation and the right heart function | ||
| 520 | |a OBJECTIVES: We aimed at describing the physiologic effects of different levels of SvO2 obtained by changing ECMO blood flow, in patients with severe ARDS receiving ECMO and controlled mechanical ventilation | ||
| 520 | |a METHODS: Low (SvO2 target 70-75%), intermediate (SvO2 target 75-80%) and high (SvO2 target > 80%) ECMO blood flows were applied for 30 minutes in random order in 20 patients. Mechanical ventilation settings were left unchanged. The hemodynamic and pulmonary effects were assessed with pulmonary artery catheter and electrical impedance tomography (EIT) | ||
| 520 | |a MEASUREMENTS AND MAIN RESULTS: Cardiac output decreased from low to intermediate and to high blood flow/SvO2 (9.2 [6.2-10.9] vs 8.3 [5.9-9.8] vs 7.9 [6.5-9.1] L/min, p = 0.014), as well as mean pulmonary artery pressure (34 ± 6 vs 31 ± 6 vs 30 ± 5 mmHg, p < 0.001), and right ventricle stroke work index (14.2 ± 4.4 vs 12.2 ± 3.6 vs 11.4 ± 3.2 g*m/beat/m2, p = 0.002). Cardiac output was inversely correlated with mixed venous and arterial PO2 values (R2 = 0.257, p = 0.031 and R2 = 0.324, p = 0.05). Pulmonary artery pressure was correlated with decreasing mixed venous PO2 (R2 = 0.29, p <0.001) and with increasing cardiac output (R2 = 0.378 p < 0.007). Measures of ventilation/perfusion mismatch did not differ between the three steps | ||
| 520 | |a CONCLUSIONS: In severe ARDS patients, increased ECMO blood flow rate resulting in higher SvO2 decreases pulmonary artery pressure, cardiac output, and right heart workload. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/) | ||
| 650 | 4 | |a Journal Article | |
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| 650 | 4 | |a extracorporeal membrane oxygenation | |
| 650 | 4 | |a pulmonary artery pressure | |
| 650 | 4 | |a right heart workload | |
| 700 | 1 | |a Giani, Marco |e verfasserin |4 aut | |
| 700 | 1 | |a Slobod, Douglas |e verfasserin |4 aut | |
| 700 | 1 | |a Pavlovsky, Bertrand |e verfasserin |4 aut | |
| 700 | 1 | |a di Pierro, Michela |e verfasserin |4 aut | |
| 700 | 1 | |a Crotti, Stefania |e verfasserin |4 aut | |
| 700 | 1 | |a Lissoni, Alfredo |e verfasserin |4 aut | |
| 700 | 1 | |a Foti, Giuseppe |e verfasserin |4 aut | |
| 700 | 1 | |a Grasselli, Giacomo |e verfasserin |4 aut | |
| 700 | 1 | |a Mauri, Tommaso |e verfasserin |4 aut | |
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