title: Flow Rate Through Pigtail Catheter Used for Left Heart Decompression in an Artificial Model of Extracorporeal Membrane Oxygenation Circuit.
abstract: In refractory cardiogenic shock, veno-arterial extracorporeal membrane oxygenation (ECMO) can be initiated. Although left heart decompression can be accomplished by insertion of a left atrial (LA) or left ventricular (LV) cannula using a percutaneous pigtail catheter, the venting flow rate according to catheter size and ECMO flow rate is unknown. We developed an artificial ECMO circuit. One liter saline bag with its pressure set to 20 mm Hg was connected to ECMO to mimic LV failure. A pigtail catheter was inserted into the 1 L saline bag to simulate LV unloading. For each pigtail catheter size (5-8 Fr) and ECMO flow rate (2.0-4.0 L/min), the moving distance of an air bubble that was injected through a three-way stopcock was measured in the arterial pressure line between the pigtail catheter and ECMO inflow limb. The flow rate was then calculated. We obtained the following equation to estimate the pigtail catheter flow rate.Pigtail vent catheter flow rate (ml/min) = 8×ECMOflow rate(L /min)+9×pigtail catheter size(Fr)- 57This equation would aid in designing of a further study to determine optimal venting flow rate. To achieve optimal venting flow, our equation would enable selection of an adequate catheter size.
authors.affiliation: From the *Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea; †Department of Thoracic and Cardiovascular Surgery, Samsung Medical center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; ‡Department of Thoracic and Cardiovascular Surgery, Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Republic of Korea; §Department of Thoracic and Cardiovascular Surgery, Jinju Hospital, Gyeongsang, National University School of Medicine, Jinju, Republic of Korea.
authors.forename: Won Ho
authors.initials: WH
authors.lastname: Kim
authors.forename: Tae Hee
authors.initials: TH
authors.lastname: Hong
authors.forename: Joung Hun
authors.initials: JH
authors.lastname: Byun
authors.forename: Jong Woo
authors.initials: JW
authors.lastname: Kim
authors.forename: Sung Hwan
authors.initials: SH
authors.lastname: Kim
authors.forename: Sung Ho
authors.initials: SH
authors.lastname: Moon
authors.forename: Hyun Oh
authors.initials: HO
authors.lastname: Park
authors.forename: Jun Young
authors.initials: JY
authors.lastname: Choi
authors.forename: Jun Ho
authors.initials: JH
authors.lastname: Yang
authors.forename: In Seok
authors.initials: IS
authors.lastname: Jang
authors.forename: Chung Eun
authors.initials: CE
authors.lastname: Lee
authors.forename: Jeong Hee
authors.initials: JH
authors.lastname: Yun
mesh_terms: D006328:Cardiac Catheterization; D019299:Decompression, Surgical; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D006333:Heart Failure / Q000628:therapy; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D012770:Shock, Cardiogenic / Q000628:therapy