The intricate physiology of veno-venous extracorporeal membrane oxygenation: an overview for clinicians.
Perfusion
; 39(1_suppl): 49S-65S, 2024 Apr.
Article
en En
| MEDLINE
| ID: mdl-38654449
ABSTRACT
During veno-venous extracorporeal membrane oxygenation (V-V ECMO), blood is drained from the central venous circulation to be oxygenated and decarbonated by an artificial lung. It is then reinfused into the right heart and pulmonary circulation where further gas-exchange occurs. Each of these steps is characterized by a peculiar physiology that this manuscript analyses, with the aim of providing bedside tools for clinical care we begin by describing the factors that affect the efficiency of blood drainage, such as patient and cannulae position, fluid status, cardiac output and ventilatory strategies. We then dig into the complexity of extracorporeal gas-exchange, with particular reference to the effects of extracorporeal blood-flow (ECBF), fraction of delivered oxygen (FdO2) and sweep gas-flow (SGF) on oxygenation and decarbonation. Subsequently, we focus on the reinfusion of arterialized blood into the right heart, highlighting the effects on recirculation and, more importantly, on right ventricular function. The importance and challenges of haemodynamic monitoring during V-V ECMO are also analysed. Finally, we detail the interdependence between extracorporeal circulation, native lung function and mechanical ventilation in providing adequate arterial blood gases while allowing lung rest. In the absence of evidence-based strategies to care for this particular group of patients, clinical practice is underpinned by a sound knowledge of the intricate physiology of V-V ECMO.
Palabras clave
acute respiratory distress syndrome; critical care medicine; extracorporeal membrane oxygenation; extracorporeal membrane oxygenation circuit; heart-lung-extracorporeal membrane oxygenation interplay; hemodynamic monitoring; pulmunary physiology; veno-venous extracorporeal membrane oxygenation; ventilator associated lung injury
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Oxigenación por Membrana Extracorpórea
Límite:
Humans
Idioma:
En
Revista:
Perfusion
Asunto de la revista:
CARDIOLOGIA
Año:
2024
Tipo del documento:
Article