About: Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is used as rescue therapy for severe cardiopulmonary failure. We tested whether the ratio of CO(2) elimination at the lung and the V-A ECMO (V̇co(2ECMO)/V̇co(2Lung)) would reflect the ratio of respective blood flows and could be used to estimate changes in pulmonary blood flow (Q̇(Lung)), i.e., native cardiac output. Four healthy pigs were centrally cannulated for V-A ECMO. We measured blood flows with an ultrasonic flow probe. V̇co(2ECMO) and V̇co(2Lung) were calculated from sidestream capnographs under constant pulmonary ventilation during V-A ECMO weaning with changing sweep gas and/or V-A ECMO blood flow. If ventilation-to-perfusion ratio (V̇/Q̇) of V-A ECMO was not 1, the V̇co(2ECMO) was normalized to V̇/Q̇ = 1 (V̇co(2ECMONorm)). Changes in pulmonary blood flow were calculated using the relationship between changes in CO(2) elimination and V-A ECMO blood flow (Q̇(ECMO)). Q̇(ECMO) correlated strongly with V̇co(2ECMONorm) (r(2) 0.95–0.99). Q̇(Lung) correlated well with V̇co(2Lung) (r(2) 0.65–0.89, P < = 0.002). Absolute Q̇(Lung) could not be calculated in a nonsteady state. Calculated pulmonary blood flow changes had a bias of 76 (−266 to 418) mL/min and correlated with measured Q̇(Lung) (r(2) 0.974–1.000, P = 0.1 to 0.006) for cumulative ECMO flow reductions. In conclusion, V̇co(2) of the lung correlated strongly with pulmonary blood flow. Our model could predict pulmonary blood flow changes within clinically acceptable margins of error. The prediction is made possible with normalization to a V̇/Q̇ of 1 for ECMO. This approach depends on measurements readily available and may allow immediate assessment of the cardiac output response.   Goto Sponge  NotDistinct  Permalink

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  • Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is used as rescue therapy for severe cardiopulmonary failure. We tested whether the ratio of CO(2) elimination at the lung and the V-A ECMO (V̇co(2ECMO)/V̇co(2Lung)) would reflect the ratio of respective blood flows and could be used to estimate changes in pulmonary blood flow (Q̇(Lung)), i.e., native cardiac output. Four healthy pigs were centrally cannulated for V-A ECMO. We measured blood flows with an ultrasonic flow probe. V̇co(2ECMO) and V̇co(2Lung) were calculated from sidestream capnographs under constant pulmonary ventilation during V-A ECMO weaning with changing sweep gas and/or V-A ECMO blood flow. If ventilation-to-perfusion ratio (V̇/Q̇) of V-A ECMO was not 1, the V̇co(2ECMO) was normalized to V̇/Q̇ = 1 (V̇co(2ECMONorm)). Changes in pulmonary blood flow were calculated using the relationship between changes in CO(2) elimination and V-A ECMO blood flow (Q̇(ECMO)). Q̇(ECMO) correlated strongly with V̇co(2ECMONorm) (r(2) 0.95–0.99). Q̇(Lung) correlated well with V̇co(2Lung) (r(2) 0.65–0.89, P < = 0.002). Absolute Q̇(Lung) could not be calculated in a nonsteady state. Calculated pulmonary blood flow changes had a bias of 76 (−266 to 418) mL/min and correlated with measured Q̇(Lung) (r(2) 0.974–1.000, P = 0.1 to 0.006) for cumulative ECMO flow reductions. In conclusion, V̇co(2) of the lung correlated strongly with pulmonary blood flow. Our model could predict pulmonary blood flow changes within clinically acceptable margins of error. The prediction is made possible with normalization to a V̇/Q̇ of 1 for ECMO. This approach depends on measurements readily available and may allow immediate assessment of the cardiac output response.
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