title: Determinants of oxygen and carbon dioxide transfer during extracorporeal membrane oxygenation in an experimental model of multiple organ dysfunction syndrome.
abstract: Extracorporeal membrane oxygenation (ECMO) has gained renewed interest in the treatment of respiratory failure since the advent of the modern polymethylpentene membranes. Limited information exists, however, on the performance of these membranes in terms of gas transfers during multiple organ failure (MOF). We investigated determinants of oxygen and carbon dioxide transfer as well as biochemical alterations after the circulation of blood through the circuit in a pig model under ECMO support before and after induction of MOF. A predefined sequence of blood and sweep flows was tested before and after the induction of MOF with fecal peritonitis and saline lavage lung injury. In the multivariate analysis, oxygen transfer had a positive association with blood flow (slope = 66, P<0.001) and a negative association with pre-membrane PaCO(2) (slope = -0.96, P = 0.001) and SatO(2) (slope = -1.7, P<0.001). Carbon dioxide transfer had a positive association with blood flow (slope = 17, P<0.001), gas flow (slope = 33, P<0.001), pre-membrane PaCO(2) (slope = 1.2, P<0.001) and a negative association with the hemoglobin (slope = -3.478, P = 0.042). We found an increase in pH in the baseline from 7.50[7.46,7.54] to 7.60[7.55,7.65] (P<0.001), and during the MOF from 7.19[6.92,7.32] to 7.41[7.13,7.5] (P<0.001). Likewise, the PCO(2) fell in the baseline from 35 [32,39] to 25 [22,27] mmHg (P<0.001), and during the MOF from 59 [47,91] to 34 [28,45] mmHg (P<0.001). In conclusion, both oxygen and carbon dioxide transfers were significantly determined by blood flow. Oxygen transfer was modulated by the pre-membrane SatO(2) and CO(2), while carbon dioxide transfer was affected by the gas flow, pre-membrane CO(2) and hemoglobin.
authors: Research and Education Institute, Hospital Sírio-Libanês, São Paulo, Brazil. marcelo.park@hc.fm.usp.br
authors: Marcelo
authors: M
authors: Park
authors: Eduardo Leite Vieira
authors: EL
authors: Costa
authors: Alexandre Toledo
authors: AT
authors: Maciel
authors: Débora Prudêncio E
authors: DP
authors: Silva
authors: Natalia
authors: N
authors: Friedrich
authors: Edzangela Vasconcelos Santos
authors: EV
authors: Barbosa
authors: Adriana Sayuri
authors: AS
authors: Hirota
authors: Guilherme
authors: G
authors: Schettino
authors: Luciano Cesar Pontes
authors: LC
authors: Azevedo
mesh_terms: D000818:Animals; D002245:Carbon Dioxide / Q000378:metabolism*; D004195:Disease Models, Animal; D015199:Extracorporeal Membrane Oxygenation; D006439:Hemodynamics; D009102:Multiple Organ Failure / Q000378:metabolism* / Q000503:physiopathology / Q000628:therapy*; D010100:Oxygen / Q000378:metabolism*; D012119:Respiration; D013552:Swine
chemical_list: D002245:Carbon Dioxide; D010100:Oxygen
references: J Appl Physiol (1985). 2006 Apr;100(4):1293-300
references: 16357067
references: Crit Care Med. 1991 Oct;19(10):1247-51
references: 1914481
references: J Biomed Mater Res B Appl Biomater. 2007 Feb;80(2):433-9
references: 16850460
references: Shock. 1998 May;9(5):364-8
references: 9617887
references: J Trauma. 2010 Aug;69(2):375-83
references: 20699747
references: Shock. 2011 Dec;36(6):604-12
references: 21921835
references: Trans Am Soc Artif Intern Organs. 1977;23:17-21
references: 910331
references: J Clin Invest. 1973 Oct;52(10):2660-3
references: 4199605
references: Clinics (Sao Paulo). 2007 Aug;62(4):491-8
references: 17823713
references: J Appl Physiol (1985). 1988 Jul;65(1):473-7
references: 3136136
references: Lancet. 2009 Oct 17;374(9698):1351-63
references: 19762075
references: Intensive Care Med. 2011 Sep;37(9):1447-57
references: 21732167
references: Circulation. 1970 Aug;42(2):195-8
references: 5431922
references: JAMA. 2009 Nov 4;302(17):1888-95
references: 19822628
references: J Cardiothorac Vasc Anesth. 2010 Feb;24(1):164-72
references: 19875307
references: Nephrol Dial Transplant. 2010 Oct;25(10):3458-9; author reply 3459
references: 20656756
references: Clin Biochem Rev. 2009 May;30(2):41-54
references: 19565024
references: Scand J Clin Lab Invest Suppl. 1977;146:15-20
references: 13478
references: Ann Card Anaesth. 2011 Sep-Dec;14(3):218-29
references: 21860197
references: J Lab Clin Med. 1991 Jun;117(6):453-67
references: 2045713
references: JAMA. 2011 Oct 19;306(15):1659-68
references: 21976615