Said M M, Rivera O, Mikesell G T, Rais-Bahrami K
Departments of Neonatology, Children's National Medical Center and The George Washington University School of Medicine, Washington, DC, USA.
Biomedical Engineering, Children's National Medical Center and The George Washington University School of Medicine, Washington, DC, USA.
J Neonatal Perinatal Med. 2017;10(2):139-145. doi: 10.3233/NPM-171692.
Recirculation of oxygenated blood in venovenous extracorporeal membrane oxygenation (VV ECMO) can decrease the oxygen delivery provided by the ECMO support. This study investigated the influence of central hemodynamics and catheter position on the amount of recirculation and oxygen delivery during VV ECMO.
Recirculation was measured in seven newborn lambs (mean weight 4.7 kg) during VV ECMO using the ELSA Monitor (Transonic Systems, Inc., Ithaca, NY) and using the central venous line (CVL) method. The ECMO pump was set at the prescribed flow of 110-120 mL/kg/min for a targeted oxygen delivery rate of 6cc/kg/min without recirculation. Hemodynamic status before and during ECMO was also measured by the COstatus Monitor (Transonic Systems, Inc.,Ithaca, NY).
Lambs with a higher cardiac index (>160 ml/min/kg), had a tendency to have higher percent oxygen delivery (65-94%, at prescribed flow) while lambs with lower cardiac index (<150 ml/min/kg), tended to have lower percent oxygen delivery (39-62%, at prescribed flow). ELSA recirculation measurements had a squared correlation coefficient R2 = 0.8 with the CVL method.
The ELSA monitor provides an easy to use, non-invasive method to measure recirculation in VV ECMO. The data suggests that cardiac function may play an important prognostic role in achieving effective VV ECMO support.
在静脉-静脉体外膜肺氧合（VV ECMO）中，氧合血的再循环会降低ECMO支持所提供的氧输送量。本研究调查了中心血流动力学和导管位置对VV ECMO期间再循环量和氧输送的影响。
使用ELSA监测仪（Transonic Systems公司，纽约州伊萨卡）并采用中心静脉导管（CVL）法，在7只新生羔羊（平均体重4.7千克）进行VV ECMO期间测量再循环。ECMO泵设置为规定流量110 - 120毫升/千克/分钟，目标氧输送率为6毫升/千克/分钟且无再循环。ECMO之前和期间的血流动力学状态也通过COstatus监测仪（Transonic Systems公司，纽约州伊萨卡）进行测量。
心脏指数较高（>160毫升/分钟/千克）的羔羊，在规定流量下有较高的氧输送百分比趋势（65 - 94%），而心脏指数较低（<150毫升/分钟/千克）的羔羊，在规定流量下有较低的氧输送百分比趋势（39 - 62%）。ELSA再循环测量值与CVL法的相关系数平方R2 = 0.8。
ELSA监测仪提供了一种易于使用的非侵入性方法来测量VV ECMO中的再循环。数据表明心脏功能可能在实现有效的VV ECMO支持中起重要的预后作用。
