Avgerinos Dimitrios V, DeBois William, Voevidko Lilia, Salemi Arash
Department of Cardiothoracic Surgery and Perioperative Services, New York Presbyterian-Weill Cornell Medical Center, Weill Cornell Medical College, New York, New York 10065, USA.
J Extra Corpor Technol. 2013 Sep;45(3):183-6.
Venoarterial extracorporeal membrane oxygenation (VA-ECMO) can be lifesaving in patients with cardiopulmonary collapse. However, observation studies have implied that oxygenated blood does not pass in a retrograde fashion from the VA-ECMO circuit to the aortic root and arch when the femoral artery (FA) is used. This study aims at accurately measuring the oxygen saturation in various arteries during VA-ECMO through different cannula sites. A total of 20 patients with VA-ECMO were in the study. Fourteen patients had FA cannulation, two patients received axillary arterial (AA) cannulation, and four patients received cannulation of the ascending aorta. Oxygen saturation was measured simultaneously in the radial artery and oxygenator outlet. In the patient group with FA cannulation, the oxygen saturation was lower in the radial artery (97%) when compared with the oxygenator outlet (> 99%). In the subset group of patients with severe lung dysfunction, oxygen saturation was even lower in the radial artery (73% saturation). In the patient group with AA cannulation, the oxygen saturation and partial oxygen pressure (PO2) in the oxygenator outlet and radial artery were similar (99% or greater). In the patient group with direct ascending aorta cannulation, the oxygen saturation and PO2 in the oxygenator outlet and radial artery were similar as well. Regional variations occur in the blood oxygen saturation depending on the site of the arterial cannulation in patients with VA-ECMO. With FA cannulation, the oxygen saturation in the radial artery is significantly lower than the one in the oxygenator outlet. This may imply that the coronaries and the brain receive hypoxic blood from the left ventricle. These results suggest that antegrade cannulation for VA-ECMO improves oxygen delivery to the proximal aorta distribution.
VA-ECMO, arterial oxygen saturation.
静脉-动脉体外膜肺氧合（VA-ECMO）对心肺功能衰竭患者可挽救生命。然而，观察性研究表明，使用股动脉（FA）时，氧合血不会以逆行方式从VA-ECMO回路进入主动脉根部和弓部。本研究旨在通过不同插管部位准确测量VA-ECMO期间各动脉的氧饱和度。共有20例VA-ECMO患者纳入研究。14例患者行FA插管，2例患者行腋动脉（AA）插管，4例患者行升主动脉插管。同时测量桡动脉和氧合器出口处的氧饱和度。在FA插管患者组中，桡动脉的氧饱和度（97%）低于氧合器出口处（>99%）。在严重肺功能障碍患者亚组中，桡动脉的氧饱和度更低（饱和度73%）。在AA插管患者组中，氧合器出口处和桡动脉的氧饱和度及部分氧分压（PO2）相似（99%或更高）。在直接升主动脉插管患者组中，氧合器出口处和桡动脉的氧饱和度及PO2也相似。VA-ECMO患者的血氧饱和度存在区域差异，取决于动脉插管部位。采用FA插管时，桡动脉的氧饱和度显著低于氧合器出口处。这可能意味着冠状动脉和大脑从左心室接受缺氧血。这些结果表明，VA-ECMO顺行插管可改善向近端主动脉分布的氧输送。
VA-ECMO，动脉血氧饱和度
