title: β-Blockers to optimize peripheral oxygenation during extracorporeal membrane oxygenation: a case series.
abstract: OBJECTIVE
  Veno-venous extracorporeal membrane oxygenation (ECMO) is a well-established therapy in patients affected by respiratory failure and unresponsive to conventional therapy. Despite technical innovations, some limitations still exist, the most important one being refractory hypoxemia. This problem is linked partially to the mixture between patients' blood and ECMO fully oxygenated blood. In the present work, the reduction of cardiac output was proposed for the treatment of refractory hypoxemia in patients with high-flow ECMO and high endogenous cardiac output.
  
  
  METHODS
  An observational study.
  
  
  METHODS
  A university hospital.
  
  
  METHODS
  Three consecutive patients suffering from persisting severe hypoxemia despite high-flow ECMO and with concomitant high cardiac output (>7 L/min).
  
  
  METHODS
  A bolus dose of 500 μg/kg and a continuous infusion of esmolol was used and titrated to an SpO(2) >92%.
  
  
  RESULTS
  Esmolol administration was safe and highly beneficial in terms of peripheral oxygenation. PaO(2) increased from 54 to 90 mmHg, from 50 to 94 mmHg, and from 49 to 66 mmHg during the first 12 hours of esmolol treatment in the 3 patients.
  
  
  CONCLUSIONS
  In selected septic, tachycardic patients with a high cardiac output, veno-venous ECMO, led to improvement of peripheral oxygenation with the addition of a short-acting β-blocker infusion.
authors.affiliation: Cardiothoracic Anaesthesia and Intensive Care Medicine, Cardiothoracic Department, University Hospital of Pisa, Pisa, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Guarracino
authors.forename: Alberto
authors.initials: A
authors.lastname: Zangrillo
authors.forename: Laura
authors.initials: L
authors.lastname: Ruggeri
authors.forename: Marina
authors.initials: M
authors.lastname: Pieri
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Calabrò
authors.forename: Giovanni
authors.initials: G
authors.lastname: Landoni
authors.forename: Maurizio
authors.initials: M
authors.lastname: Stefani
authors.forename: Luca
authors.initials: L
authors.lastname: Doroni
authors.forename: Federico
authors.initials: F
authors.lastname: Pappalardo
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000494:pharmacology / Q000627:therapeutic use*; D002302:Cardiac Output / Q000187:drug effects / Q000502:physiology; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D006801:Humans; D000860:Hypoxia / Q000188:drug therapy* / Q000503:physiopathology / Q000628:therapy; D010101:Oxygen Consumption / Q000187:drug effects / Q000502:physiology; D012128:Respiratory Distress Syndrome / Q000188:drug therapy* / Q000503:physiopathology / Q000628:therapy; D012131:Respiratory Insufficiency / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists