Lindstrom S J, Mennen M T, Rosenfeldt F L, Salmonsen R F
Internal Medicine, The Alfred Hospital, Melbourne, Australia.
Perfusion. 2012 Nov;27(6):464-9. doi: 10.1177/0267659112450744. Epub 2012 Jun 25.
Veno-venous extracorporeal membrane oxygenation has several advantages over veno-arterial support for patients with severe reversible respiratory failure. However, recirculation can limit oxygen delivery as pump flow increases. This could be ameliorated by placing the return catheter in the right ventricle instead of the central veins. We compared recirculation in veno-right ventricular support with that in conventional veno-venous support and its relationship with pump flow.
Five greyhound dogs were sequentially cannulated percutaneously for both veno-venous and veno-right ventricular support. Recirculation was measured by comparing oxygen levels in the circuit drainage and return lines before and immediately after a sudden increase in circuit oxygenation at pump flows between 0.5 L/min and 4 L/min for both modalities.
Recirculation was reduced in veno-right ventricular support compared with conventional veno-venous support at 4 L/min pump flow (8.4% versus 37.9%, p=0.0076) and increased less with increases in pump flow (2.9% per 1 L/min vs. 11.1% per 1 L/min, p<0.0001).
Recirculation can be dramatically reduced by returning blood into the right ventricle, which improves oxygen delivery to the lungs and the systemic circulation. The design of specialized catheters may facilitate percutaneous ventricular cannulation, improve safety and further reduce recirculation.
对于严重可逆性呼吸衰竭患者，静脉-静脉体外膜肺氧合相对于静脉-动脉支持具有若干优势。然而，随着泵流量增加，再循环会限制氧输送。将回流导管置于右心室而非中心静脉可改善这一情况。我们比较了静脉-右心室支持与传统静脉-静脉支持中的再循环情况及其与泵流量的关系。
对5只灵缇犬依次进行经皮插管，以实现静脉-静脉和静脉-右心室支持。通过比较两种模式在泵流量为0.5 L/分钟至4 L/分钟时回路突然增加氧合之前和之后回路引流管和回流管中的氧水平来测量再循环。
在泵流量为4 L/分钟时，静脉-右心室支持中的再循环较传统静脉-静脉支持减少（8.4%对37.9%，p = 0.0076），且随着泵流量增加其增加幅度较小（每1 L/分钟增加2.9%对每1 L/分钟增加11.1%，p < 0.0001）。
将血液回流至右心室可显著减少再循环，这改善了肺和体循环的氧输送。专门导管的设计可能有助于经皮心室插管，提高安全性并进一步减少再循环。
