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Hemodynamic response to pumpless extracorporeal membrane oxygenation
1Division of Cardiothoracic Surgery, Case Western Reserve University, Cleveland, Ohio.
The Journal of Thoracic and Cardiovascular Surgery
|April 1, 1990
Summary
Pumpless arteriovenous extracorporeal membrane oxygenation (AV-ECMO) offers simplicity but can harm hemodynamics. Inotropic medication can help manage these adverse effects during respiratory support.
Area of Science:
- Cardiovascular Physiology
- Respiratory Medicine
- Extracorporeal Life Support
Background:
- Arteriovenous extracorporeal membrane oxygenation (AV-ECMO) is a simpler alternative to pump-driven venoarterial ECMO for respiratory support.
- While improving blood gases, AV-ECMO may negatively impact systemic and pulmonary hemodynamics.
Purpose of the Study:
- To investigate the hemodynamic consequences of AV-ECMO in a canine model.
- To assess the efficacy of dopamine and volume expansion in mitigating these effects.
Main Methods:
- 11 anesthetized and heparinized dogs were studied before and after inducing pulmonary edema.
- Mechanical ventilation with FIO2 = 0.21 was maintained.
- Hemodynamic parameters were monitored during AV-ECMO and interventions.
Main Results:
- Adequate AV-ECMO flows for gas exchange caused significant decreases in peripheral vascular resistance (-46%) and blood pressure (-20%), with a marked increase in cardiac output (+110%).
- Dopamine infusion was more effective than volume expansion in stabilizing cardiac output, blood pressure, and blood gases.
- Moderate inotropic medication beneficially modulated the adverse hemodynamic alterations.
Conclusions:
- Pumpless AV-ECMO, at flow rates sufficient for respiratory support, can adversely affect systemic hemodynamics.
- Inotropic agents can effectively manage these hemodynamic changes, suggesting a potential role in clinical applications.