title: A brief clinical case of monitoring of oxygenator performance and patient-machine interdependency during prolonged veno-venous extracorporeal membrane oxygenation.
abstract: Monitoring veno-venous extracorporeal membrane oxygenation (vvECMO) during 76 days of continuous support in a 42-years old patient with end-stage pulmonary disease, listed for double-lung transplantation. Applying a new monitor (Landing®, Eurosets, Medolla, Italy) and describing how measured and calculated parameters can be used to understand the variable interdependency between artificial membrane lung (ML) and patient native lung (NL). During vvECMO, in order to understand how the respiratory function is shared between ML and NL, ideally we should obtain data about oxygen transfer and CO2removal, both by ML and NL. Measurements for NL can be made on the mechanical ventilator. Measurements for ML are typically made from gas analysis on blood samples drawn from the ECMO system before and after the oxygenator, and therefore are non-continuous. Differently, the Landing monitor provides a continuous measurement of the oxygen transfer from the ML, combined with hemoglobin level, saturation of drained blood and saturation of reinfused blood. Moreover, the Landing monitor provides hemodynamics data about circulation through the ECMO system, with blood flow, pre-oxygenator pressure and post-oxygenator pressure. Of note, measurements include the drain negative pressure, whose monitoring may be particularly useful to prevent hemolysis. Real-time monitoring of vvECMO provides data helpful to understand the complex picture of a patient with severely damaged lungs on one side and an artificial lung on the other side. Data from vvECMO monitoring may help to adapt the settings of both mechanical ventilator and vvECMO. Data about oxygen transfer by the oxygenator are important to evaluate the performance of the device and may help to avoid unnecessary replacements, thus reducing risks and costs.
authors: S.C. Anestesia e Rianimazione 2, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. m.belliato@smatteo.pv.it.
authors: Mirko
authors: http://orcid.org/0000-0002-3411-6293
authors: M
authors: Belliato
authors: S.C. Cardiochirurgia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors: Antonella
authors: A
authors: Degani
authors: Dipartimento di Scienze Mediche, Chirurgiche, Diagnostiche e Pediatriche, Università degli Studi di Pavia, Pavia, Italy.
authors: Antonino
authors: A
authors: Buffa
authors: S.C. Anestesia e Rianimazione 2, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors: Fabio
authors: F
authors: Sciutti
authors: S.C. Anestesia e Rianimazione 2, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors: Michele
authors: M
authors: Pagani
authors: S.C. Cardiochirurgia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.|Dipartimento di Scienze Mediche, Chirurgiche, Diagnostiche e Pediatriche, Università degli Studi di Pavia, Pavia, Italy.
authors: Carlo
authors: C
authors: Pellegrini
authors: S.C. Anestesia e Rianimazione 2, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors: Giorgio Antonio
authors: GA
authors: Iotti
mesh_terms: D000328:Adult; D001784:Blood Gas Analysis / Q000379:methods*; D002245:Carbon Dioxide / Q000737:chemistry; D003422:Critical Care / Q000379:methods; D004867:Equipment Design; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005355:Fibrosis / Q000503:physiopathology; D006439:Hemodynamics; D006801:Humans; D007362:Intensive Care Units; D008168:Lung / Q000473:pathology*; D008297:Male; D008991:Monitoring, Physiologic; D010100:Oxygen / Q000097:blood* / Q000737:chemistry; D010106:Oxygenators; D011014:Pneumonia / Q000503:physiopathology; D012119:Respiration; D012121:Respiration, Artificial
chemical_list: D002245:Carbon Dioxide; D010100:Oxygen
keywords: ECMO monitoring; Membrane lung function; Oxygenator performance; Respiratory support; monitoring