title: Effect of bladderbox alarms during venoarterial extracorporeal membrane oxygenation on cerebral oxygenation and hemodynamics in lambs.
abstract: To determine the effects of bladderbox alarms during venoarterial extracorporeal membrane oxygenation (va-ECMO) on cerebral oxygenation and hemodynamics, six lambs were prospectively treated with va-ECMO and bladderbox alarms were simulated. Changes in concentrations of oxyhemoglobin (deltacO2Hb), deoxyhemoglobin (deltacHHb), and total Hb (deltactHb) were measured using near infrared spectrophotometry. Fluctuations in Hb oxygenation index (deltaHbD) and cerebral blood volume (deltaCBV) were calculated. Heart rate (HR), mean arterial pressure (MAP), blood flow in the left carotid artery (Qcar), and central venous pressure (CVP) were registered. Bladderbox alarms were simulated by increasing the ECMO flow or partially clamping the venous cannula and resolved by decreasing the ECMO flow, unclamping the cannula, or intravascular volume administration. CBV, HbD, MAP, and Qcar decreased significantly during bladderbox alarms, whereas HR and CVP increased. After the bladderbox alarms, CBV and HbD increased significantly to values above baseline. For HbD, this increase was higher during intravascular volume administration.MAP, Qcar, and CVP recovered to preexperiment values but increased further with volume administration. HR was increased at the end of our measurements. We conclude that Bladderbox alarms during va-ECMO treatment result in significant fluctuations in cerebral oxygenation and hemodynamics, a possible risk factor for intracranial lesions.
authors.affiliation: Department of Pediatrics, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands. a.c.demol@cukz.umcn.nl
authors.forename: Amerik C
authors.initials: AC
authors.lastname: de Mol
authors.forename: Luella C
authors.initials: LC
authors.lastname: Gerrits
authors.forename: Arno F J
authors.initials: AF
authors.lastname: van Heijst
authors.forename: Jan
authors.initials: J
authors.lastname: Menssen
authors.forename: Frans H J M
authors.initials: FH
authors.lastname: van der Staak
authors.forename: Kian D
authors.initials: KD
authors.lastname: Liem
mesh_terms: D000818:Animals; D001783:Blood Flow Velocity / Q000502:physiology; D001794:Blood Pressure; D001921:Brain / Q000098:blood supply / Q000378:metabolism*; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D006339:Heart Rate; D006454:Hemoglobins / Q000378:metabolism; D010107:Oxygenators, Membrane; D012039:Regional Blood Flow; D012756:Sheep; D019265:Spectroscopy, Near-Infrared
chemical_list: D006454:Hemoglobins