Superior vena cava drainage improves upper body oxygenation during veno-arterial extracorporeal membrane oxygenation in sheep

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• 作者：Xiaotong Hou (1) (2)
  Xiaofang Yang (1) (2)
  Zhongtao Du (1) (2)
  Jialin Xing (1) (2)
  Hui Li (2) (3)
  Chunjing Jiang (1) (2)
  Jinhong Wang (1) (2)
  Zhichen Xing (1) (2)
  Shuanglei Li (1)
  Xiaokui Li (4)
  Feng Yang (1) (2)
  Hong Wang (1) (2)
  Hui Zeng (5) (6)
  
  1. Center for Cardiac Intensive Care ; Beijing Anzhen Hospital ; Capital Medical University ; 2 Anzhen Road ; Beijing ; 100029 ; P.R. China
  2. Beijing Institute of Heart Lung and Blood Vessel Diseases ; 2 Anzhen Road ; Beijing ; 100029 ; P.R. China
  3. Department of Cardiac Surgery ; Beijing Anzhen Hospital ; Capital Medical University ; 2 Anzhen Road ; Beijing ; 100029 ; P.R. China
  4. Department of Anaesthesia ; Beijing New Century Women鈥檚 and Children鈥檚 Hospital ; Wangjing North Road ; Beijing ; 100029 ; P.R. China
  5. Institute of Infectious Diseases ; Beijing Ditan Hospital ; Capital Medical University ; 8 East Jing Shun Road ; Beijing ; 100015 ; P.R. China
  6. Beijing Key Laboratory of Emerging Infectious Diseases ; Jingshundongjie 8 ; Beijing ; 100015 ; P.R. China
  
• 刊名：Critical Care
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：19
• 期：1
• 全文大小：2,741 KB
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• 刊物主题：Intensive / Critical Care Medicine; Emergency Medicine;
• 出版者：BioMed Central
• ISSN：1364-8535

文摘

Introduction Differential hypoxia is a pivotal problem in patients with femoral veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) support. Despite recognition of differential hypoxia and attempts to deliver more oxygenated blood to the upper body, the mechanism of differential hypoxia as well as prevention strategies have not been well investigated. Methods We used a sheep model of acute respiratory failure that was supported with femoral VA ECMO from the inferior vena cava to the femoral artery (IVC-FA), ECMO from the superior vena cava to the FA (SVC-FA), ECMO from the IVC to the carotid artery (IVC-CA) and ECMO with an additional return cannula to the internal jugular vein based on the femoral VA ECMO (FA-IJV). Angiography and blood gas analyses were performed. Results With IVC-FA, blood oxygen saturation (SO2) of the IVC (83.6鈥壜扁€?.8%) was higher than that of the SVC (40.3鈥壜扁€?.0%). Oxygen-rich blood was drained back to the ECMO circuit and poorly oxygenated blood in the SVC entered the right atrium (RA). SVC-FA achieved oxygen-rich blood return from the IVC to the RA without shifting the arterial cannulation. Subsequently, SO2 of the SVC and the pulmonary artery increased (70.4鈥壜扁€?.0% and 73.4鈥壜扁€?.1%, respectively). Compared with IVC-FA, a lesser difference in venous oxygen return and attenuated differential hypoxia were observed with IVC-CA and FA-IJV. Conclusions Differential venous oxygen return is a key factor in the etiology of differential hypoxia in VA ECMO. With knowledge of this mechanism, we can apply better cannula configurations in clinical practice.