Differential hypoxemia and the clinical significance of venous drainage position during extracorporeal membrane oxygenation

被引:8
作者
Falk, Lars [1 ,2 ]
Hultman, Jan [1 ,2 ]
Broman, Lars M. [1 ,2 ]
机构
[1] Karolinska Inst, Dept Physiol & Pharmacol, Stockholm, Sweden
[2] Karolinska Univ Hosp, Dept Pediat Perioperat Med & Intens Care, ECMO Ctr Karolinska, Stockholm, Sweden
来源
PERFUSION-UK | 2023年 / 38卷 / 04期
关键词
differential hypoxemia; north-south syndrome; Harlequin phenomenon; veno-arterial; extracorporeal membrane oxygenation; hypoxia; VENOARTERIAL BYPASS; LIFE-SUPPORT;
D O I
10.1177/02676591221090667
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Differential hypoxemia (DH) has been recognized as a clinical problem during veno-arterial extracorporeal membrane oxygenation (VA ECMO) although its features and consequences have not been fully elucidated. Purpose: This single center retrospective study aimed to investigate the clinical characteristics of patients manifesting DH as well as the impact of repositioning the drainage point from the inferior vena cava (IVC) to the superior vena cava to alleviate DH. Methods: All patients (>15 years) commenced on VA ECMO at our center between 2009 and 2020 were screened. Of 472 eligible patients seven were identified with severe DH. All patients had the drainage cannula tip in the IVC or at the junction between the IVC and right atrium. Results: The mean peripheral capillary saturation increased from 54 (+/- 6.6) to 86 (+/- 6.6) %, (p = <0.001) after repositioning of the cannula. Pre-oxygenator saturation increased from 62 (+/- 8.9) % prior to adjustment to 74 (+/- 3.7) %, (p = 0.016) after repositioning. Plasma lactate tended to decrease within 24 h after adjustment. Five patients (71%) survived ECMO treatment, to discharge from hospital, and were alive at 1-year follow-up. Conclusion: Although DH has been described in several studies, the condition has not been investigated in a clinical setting comparing the effect on upper body saturation before and after repositioning of the drainage cannula. This study shows that moving the drainage zone into the upper part of the body has a marked positive effect on upper body saturation in patients with DH.
引用
收藏
页码:818 / 825
页数:8
相关论文
共 20 条
[11]   Flow-induced platelet activation in components of the extracorporeal membrane oxygenation circuit [J].
Fuchs, Gabriel ;
Berg, Niclas ;
Broman, L. Mikael ;
Wittberg, Lisa Prahl .
SCIENTIFIC REPORTS, 2018, 8
[12]   Extracorporeal life support for acute respiratory distress syndromes [J].
Hayes, Don, Jr. ;
Tobias, Joseph D. ;
Kukreja, Jasleen ;
Preston, Thomas J. ;
Yates, Andrew R. ;
Kirkby, Stephen ;
Whitson, Bryan A. .
ANNALS OF THORACIC MEDICINE, 2013, 8 (03) :133-141
[13]   Superior vena cava drainage improves upper body oxygenation during veno-arterial extracorporeal membrane oxygenation in sheep [J].
Hou, Xiaotong ;
Yang, Xiaofang ;
Du, Zhongtao ;
Xing, Jialin ;
Li, Hui ;
Jiang, Chunjing ;
Wang, Jinhong ;
Xing, Zhichen ;
Li, Shuanglei ;
Li, Xiaokui ;
Yang, Feng ;
Wang, Hong ;
Zeng, Hui .
CRITICAL CARE, 2015, 19
[14]   Effective cross-circulation technique of venoarterial bypass for differential hypoxia condition [J].
Kitamura, M ;
Shibuya, M ;
Kurihara, H ;
Akimoto, T ;
Endo, M ;
Koyanagi, H .
ARTIFICIAL ORGANS, 1997, 21 (07) :786-788
[15]   Venous Cannula Positioning in Arterial Deoxygenation During Veno-Arterial Extracorporeal Membrane Oxygenation-A Simulation Study and Case Report [J].
Lindfors, Mattias ;
Frenckner, Bjoern ;
Sartipy, Ulrik ;
Bjaellmark, Anna ;
Broome, Michael .
ARTIFICIAL ORGANS, 2017, 41 (01) :75-81
[16]   Cannulation for veno-venous extracorporeal membrane oxygenation [J].
Lindholm, Jonas Andersson .
JOURNAL OF THORACIC DISEASE, 2018, 10 :S606-S612
[17]   A numerical study on the effect of side hole number and arrangement in venous cannulae [J].
Park, J. Y. ;
Park, C. Y. ;
Min, B. G. .
JOURNAL OF BIOMECHANICS, 2007, 40 (05) :1153-1157
[18]   Predicting survival after ECMO for refractory cardiogenic shock: the survival after veno-arterial-ECMO (SAVE)-score [J].
Schmidt, Matthieu ;
Burrell, Aidan ;
Roberts, Lloyd ;
Bailey, Michael ;
Sheldrake, Jayne ;
Rycus, Peter T. ;
Hodgson, Carol ;
Scheinkestel, Carlos ;
Cooper, D. Jamie ;
Thiagarajan, Ravi R. ;
Brodie, Daniel ;
Pellegrino, Vincent ;
Pilcher, David .
EUROPEAN HEART JOURNAL, 2015, 36 (33) :2246-2256
[19]   The Richmond Agitation-Sedation Scale - Validity and reliability in adult intensive care unit patients [J].
Sessler, CN ;
Gosnell, MS ;
Grap, MJ ;
Brophy, GM ;
O'Neal, PV ;
Keane, KA ;
Tesoro, EP ;
Elswick, RK .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2002, 166 (10) :1338-1344
[20]   Managing Harlequin Syndrome in VA-ECMO - do not forget the right ventricle [J].
Wilson, James ;
Fisher, Richard ;
Caetano, Francisca ;
Soliman-Aboumarie, Hatem ;
Patel, Brijesh ;
Ledot, Stephane ;
Price, Susanna ;
Vandenbriele, Christophe .
PERFUSION-UK, 2022, 37 (05) :526-529