Physiologic Effects of Extracorporeal Membrane Oxygenation in Patients with Severe Acute Respiratory Distress Syndrome.

Abstract

<b>Rationale:</b> Blood flow rate affects mixed venous oxygenation (Sv_O₂) during venovenous extracorporeal membrane oxygenation (ECMO), with possible effects on the pulmonary circulation and the right heart function. <b>Objectives:</b> To describe the physiologic effects of different levels of Sv_O₂ obtained by changing ECMO blood flow in patients with severe acute respiratory distress syndrome receiving ECMO and controlled mechanical ventilation. <b>Methods:</b> Low (Sv_O₂ target, 70-75%), intermediate (Sv_O₂ target, 75-80%), and high (Sv_O₂ target, >80%) ECMO blood flows were applied for 30 minutes in random order in 20 patients. Mechanical ventilation settings were left unchanged. The hemodynamic and pulmonary effects were assessed with pulmonary artery catheter and electrical impedance tomography. <b>Measurements and Main Results:</b> Cardiac output decreased from low to intermediate and to high blood flow/Sv_O₂ (9.2 [6.2-10.9] vs. 8.3 [5.9-9.8] vs. 7.9 [6.5-9.1] L/min; <i>P</i> = 0.014), as well as mean pulmonary artery pressure (34 ± 6 vs. 31 ± 6 vs. 30 ± 5 mm Hg; <i>P</i> < 0.001) and right ventricular stroke work index (14.2 ± 4.4 vs. 12.2 ± 3.6 vs. 11.4 ± 3.2 g × m/beat/m²; <i>P</i> = 0.002). Cardiac output was inversely correlated with mixed venous and arterial Po₂ values (<i>R</i>² = 0.257; <i>P</i> = 0.031; and <i>R</i>² = 0.324; <i>P</i> = 0.05). Pulmonary artery pressure was correlated with decreasing mixed venous Po₂ (<i>R</i>² = 0.29; <i>P</i> < 0.001) and with increasing cardiac output (<i>R</i>² = 0.378; <i>P</i> < 0.007). Measures of [Formula: see text]/[Formula: see text] mismatch did not differ between the three steps. <b>Conclusions:</b> In patients with severe acute respiratory distress syndrome, increased ECMO blood flow rate resulting in higher Sv_O₂ decreases pulmonary artery pressure, cardiac output, and right heart workload.