Why the study?
Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a rescue strategy for severe cardiopulmonary failure, but the estimation of cardiac output during VA-ECMO is challenging.
Can cardiac output be accurately estimated using gas exchange during VA-ECMO in a simulation model?
Can cardiac output be accurately estimated using gas exchange during VA-ECMO in a simulation model?
A modified Fick principle based on gas exchange can estimate cardiac output during VA-ECMO in a simulation model using paediatric oxygenators.
Simulation suggests gas exchange may estimate native cardiac output on VA-ECMO; clinical validation needed before adoption.
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 ( Q̇ Q ˙ Lung ) and an ECMO circuit ( Q̇ Q ˙ ECMO ) with oxygenators for CO 2 removal ( V. V . CO 2 ) and O 2 uptake ( V. V . O 2 ) simulated the setting of VA-ECMO with varying ventilation/perfusion ( V. V . / Q̇ Q ˙ ) ratios and shunt. A metabolic chamber with a CO 2 /N 2 blend simulated V. V . CO 2 and V. V . O 2 . Q̇ Q ˙ Lung was estimated with a modified Fick principle: Q̇ Q ˙ Lung = Q̇ Q ˙ ECMO × ( V. V . CO 2 or V. V . O 2Lung )/( V. V . CO 2 or V. V . O 2ECMO ). A normalization procedure corrected V. V . CO 2 values for a V. V . / Q̇ Q ˙ of 1. Method agreement was evaluated by Bland–Altman analysis. Calculated Q̇ Q ˙ Lung using gaseous V. V . CO 2 and V. V . O 2 correlated well with measured Q̇ Q ˙ 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 V. V . CO 2</jat
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Bachmann et al. (2021) studied this question.
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