Tamesue Kiyokazu, Ichiba Shingo, Nawa Sugato, Shimizu Nobuyoshi
Department of Cancer and Thracic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan.
Acta Med Okayama. 2006 Jun;60(3):167-72. doi: 10.18926/AMO/30748.
This study was carried out to determine whether an extracorporeal membrane oxygenation (ECMO) support could be sufficiently conducted by the right ventricle alone from the viewpoint of the hemodynamics and blood gas state. Six infant dogs underwent a bypass between the left pulmonary artery and left atrium with an in-line oxygenator after a left pneumonectomy. Partial ECMO support was conducted simply by opening the circuit, and total ECMO support was conducted by ligating the right pulmonary artery. After the establishment of partial ECMO, approximately one-third of the right ventricular output was passively shunted through the bypass circuit, and the cardiac index and central venous pressure did not change. The mean pulmonary arterial pressures increased significantly. After a complete ligation of the right pulmonary artery, all 6 dogs survived for 12 h, but the cardiac output and blood pressure decreased significantly. The blood gas state was sufficiently maintained throughout the experiment. The results suggest the possibility of using the pumpless ECMO support. However, the flow resistance of the membrane oxygenator proved to still be too high for use in a total pumpless ECMO. Further studies on long-term ECMO and the development of a membrane oxygenator with a considerably low flow-resistance are needed.
本研究旨在从血流动力学和血气状态的角度确定仅通过右心室是否能够充分进行体外膜肺氧合（ECMO）支持。六只幼犬在左肺切除术后，通过带在线氧合器在左肺动脉和左心房之间建立旁路。部分ECMO支持通过简单打开回路来进行，而完全ECMO支持则通过结扎右肺动脉来进行。在建立部分ECMO后，约三分之一的右心室输出量通过旁路回路被动分流，心脏指数和中心静脉压未发生变化。平均肺动脉压显著升高。在完全结扎右肺动脉后，所有6只犬存活了12小时，但心输出量和血压显著下降。在整个实验过程中，血气状态得到了充分维持。结果提示了使用无泵ECMO支持的可能性。然而，膜式氧合器的流动阻力对于完全无泵ECMO来说仍然过高。需要对长期ECMO进行进一步研究，并开发流动阻力相当低的膜式氧合器。
