How to avoid rapid carbon dioxide changes at the start of veno-venous extracorporeal membrane oxygenation: Role of end-tidal CO2 monitoring

Abstract

Background: Venovenous ECMO is a lifesaving technique for patients with severe respiratory failure. Management of carbon dioxide (CO₂) levels at ECMO start is crucial, as recent studies found an association between rapid CO₂ shifts and increased incidence of neurological complications.

Purpose: To describe the role of end tidal CO₂ (etCO₂) monitoring at the ECMO start to minimize carbon dioxide shifts.

Research design: Retrospective cohort study.

Methods: We performed a retrospective analysis of patients who started venovenous ECMO support at our institution between 2011 and 2021. We analysed the minute-by-minute variations of etCO₂, ventilatory parameters and arterial blood gas before and after the ECMO start.

Results: 36 patients with a complete dataset of parameters were included. After the ECMO start, minute ventilation was progressively reduced from 10.8±;3.3 to 2.9±1.2 L/min (p<0.001). etCO₂ did not vary significantly (baseline 37±10 vs 35±9 mmHg 20 minutes after ECMO start, p = 0.36). Despite a stable etCO₂ level, a mild drop of arterial CO₂ tension (9.5 mmHg, corresponding to a 18% change) was recorded at the first ABG sampled after the ECMO start. No patient developed neurological complications after the ECMO commencement.

Conclusion: etCO₂ monitoring during ECMO start is feasible and allows to adjust gas flow and ventilator settings to limit changes in arterial CO₂ levels.

Keywords

Veno-venous extracorporeal membrane oxygenation extracorporeal membrane oxygenation intracranial bleeding acute respiratory distress syndrome carbon dioxide

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References

Luyt

C-E

Bréchot

Demondion

, et al. Brain injury during venovenous extracorporeal membrane oxygenation. Intensive Care Med 2016; 42(5): 897–907.

Fletcher Sandersjöö

Bartek

Jr Thelin

, et al. Predictors of intracranial hemorrhage in adult patients on extracorporeal membrane oxygenation: an observational cohort study. J Intensive Care 2017; 5(1): 27.

Cavayas

Munshi

Del Sorbo

, et al. The early change in PaCO2 after extracorporeal membrane oxygenation initiation is associated with neurological complications. Am J Respir Crit Care Med 2020; 201(12): 1525–1535.

Bembea

Lee

Masten

, et al. Magnitude of arterial carbon dioxide change at initiation of extracorporeal membrane oxygenation support is associated with survival. J Extra Corpor Technol 2013; 45(1): 26–32.

Kredel

Lubnow

Westermaier

, et al. Cerebral tissue oxygenation during the initiation of venovenous ECMO. ASAIO J 2014; 60(6): 694–700.

Extracorporeal Life Support Organization (ELSO) . Guidelines for adult respiratory failure v 1. 4, 2017.

Combes

Hajage

Capellier

, et al. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. New Engl J Med 2018; 378(21): 1965–1975.

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