How I manage differential gas exchange in peripheral venoarterial extracorporeal membrane oxygenation

Critical Care

Perspective

Dana A. Mullin¹  Justin A. Fried²  Eric C. Siddall³  Daniel Brodie⁴  Cara L. Agerstrand⁵  Darryl Abrams⁵  Philippe H. Lemaitre⁶  Joshua R. Sonett⁶  Richa Asija⁷ 

[1] Clinical Perfusion, Columbia University Irving Medical Center, New York, NY, USA;Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA;Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA;Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA;Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center, 177 Ft. Washington Avenue, 10032, New York, NY, USA;Division of Thoracic Surgery, Columbia University Irving Medical Center, New York, NY, USA;Division of Thoracic Surgery, Columbia University Irving Medical Center, New York, NY, USA;Department of Surgery, Community Memorial Health Systems, Ventura, CA, USA;

关键词: Competitive flow;    Dual circulation;    Differential oxygenation;    Differential carbon dioxide;    Mixing point;    Venoarterial extracorporeal membrane oxygenation;   

DOI  :  10.1186/s13054-023-04703-3

 received in 2023-09-14, accepted in 2023-10-22,  发布年份 2023

来源: Springer

【 摘 要 】

Dual circulation is a common but underrecognized physiological occurrence associated with peripheral venoarterial extracorporeal membrane oxygenation (ECMO). Competitive flow will develop between blood ejected from the heart and blood travelling retrograde within the aorta from the ECMO reinfusion cannula. The intersection of these two competitive flows is referred to as the “mixing point”. The location of this mixing point, which depends upon the relative strengths of the native and extracorporeal pumps, will determine which regions of the body are perfused with blood ejected from the left ventricle and which regions are perfused by reinfused blood from the ECMO circuit, effectively establishing dual circulations. Because gas exchange within these circulations is dictated by the native lungs and membrane lung, respectively, oxygenation and carbon dioxide removal may differ between regions—depending on how well gas exchange is preserved within each circulation—potentially leading to differential oxygenation or differential carbon dioxide, each of which may have important clinical implications. In this perspective, we address the identification and management of dual circulation and differential gas exchange through various clinical scenarios of venoarterial ECMO. Recognition of dual circulation, proper monitoring for differential gas exchange, and understanding the various strategies to resolve differential oxygenation and carbon dioxide may allow for more optimal patient management and improved clinical outcomes.

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

Fig. 1