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

被引：7

作者：

Bachmann, Kaspar Felix ^{[1
,2
]}

Vasireddy, Rakesh ^{[1
]}

Heinisch, Paul Philipp ^{[3
,4
]}

Jenni, Hansjoerg ^{[3
]}

Vogt, Andreas ^{[1
]}

Berger, David ^{[2
]}

机构：

[1] Univ Bern, Bern Univ Hosp, Dept Anaesthesiol & Pain Med, Inselspital, Bern, Switzerland

[2] Univ Bern, Bern Univ Hosp, Dept Intens Care Med, Inselspital, Bern, Switzerland

[3] Univ Bern, Bern Univ Hosp, Dept Cardiac & Vasc Surg, Inselspital, Bern, Switzerland

[4] Tech Univ Munich, German Heart Ctr Munich, Dept Congenital & Pediat Heart Surg, Munich, Germany

来源：

SCIENTIFIC REPORTS | 2021年 / 11卷 / 01期

关键词：

CARBON-DIOXIDE; VENTILATION; FLOW; COMPONENTS; AGREEMENT; ECMO;

D O I：

10.1038/s41598-021-90747-w

中图分类号：

O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];

学科分类号：

07 ; 0710 ; 09 ;

摘要：

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 (Q</mml:mover>(Lung)) and an ECMO circuit (Q</mml:mover>(ECMO)) with oxygenators for CO2 removal (V.</mml:mover>CO2) and O-2 uptake (V.</mml:mover>O-2) simulated the setting of VA-ECMO with varying ventilation/perfusion (V.</mml:mover>/Q</mml:mover>) ratios and shunt. A metabolic chamber with a CO2/N-2 blend simulated V.</mml:mover>CO2 and V.</mml:mover>O-2. Q</mml:mover>(Lung) was estimated with a modified Fick principle: Q</mml:mover>(Lung)=Q</mml:mover>(ECMO) x (V.</mml:mover> CO2 or V.</mml:mover>O-2Lung)/(V.</mml:mover>CO2 or <mml:mover>V<mml:mo>.</mml:mover>O-2ECMO). A normalization procedure corrected <mml:mover>V<mml:mo>.</mml:mover>CO2 values for a <mml:mover>V<mml:mo>.</mml:mover>/<mml:mover accent="true">Q<mml:mo></mml:mover> of 1. Method agreement was evaluated by Bland-Altman analysis. Calculated <mml:mover accent="true">Q<mml:mo></mml:mover>(Lung) using gaseous <mml:mover>V<mml:mo>.</mml:mover>CO2 and <mml:mover>V<mml:mo>.</mml:mover>O-2 correlated well with measured <mml:mover accent="true">Q<mml:mo></mml:mover>(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], r(2) 0.85 [0.79-0.88]). Blood measurements of <mml:mover>V<mml:mo>.</mml:mover>CO2 showed an increased bias (- 260 ml/min [- 1503 to 982] ml/min), clinically not applicable. Shunt and <mml:mover>V<mml:mo>.</mml:mover>/<mml:mover accent="true">Q<mml:mo></mml:mover> mismatch decreased the agreement of methods significantly. This in-vitro simulation shows that <mml:mover>V<mml:mo>.</mml:mover>CO2 and <mml:mover>V<mml:mo>.</mml:mover>O-2 in steady-state conditions allow for clinically applicable calculations of <mml:mover accent="true">Q<mml:mo></mml:mover>(Lung) during VA-ECMO therapy.

引用

页数：14

共 38 条

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