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Improved oxygenation with reduced recirculation during venovenous extracorporeal membrane oxygenation: evaluation of a test catheter.
Crit Care Med. 1995 Oct; 23(10):1722-5.CC

Abstract

OBJECTIVE

To determine whether modifications of the original design of a double-lumen, venovenous, extracorporeal membrane oxygenation (ECMO) catheter would reduce recirculation and improve oxygenation during venovenous ECMO.

DESIGN

Prospective, interventional study.

SETTING

The animal research laboratory at The Children's National Medical Center.

SUBJECTS

Six newborn lambs, 1 to 7 days old and weighing 4.7 +/- 0.9 kg.

INTERVENTIONS

Animals were anesthetized, intubated and ventilated. The ductus arteriosus was ligated. Femoral artery and vein, cephalic jugular vein, and pulmonary artery catheters were placed. After systemic heparinization, the test catheter (with venous drainage holes moved away from the arterial return holes) was placed in the right internal jugular vein and advanced into the right atrium. The animal was placed on ECMO and stabilized, with the ventilator settings decreased to a peak inspiratory pressure of 15 cm H2O, peak positive end-expiratory pressure of 5 cm H2O, respiratory rate of 15 breaths/min, and an FIO2 of 0.21. ECMO flows were increased in 100-mL increments from 200 to 600 mL/min, with measurements taken 15 mins after each change. The test catheter was removed, the double-lumen, venovenous ECMO catheter was placed, and the studies were repeated.

MEASUREMENTS AND MAIN RESULTS

Heart rate, mean arterial pressure, PaO2, jugular cerebral oxygen saturation, pulmonary artery oxygen saturation, mixed venous oxygen saturation, and postmembrane circuit pressures were measured at each study period. The test catheter improved oxygenation significantly, with higher systemic PaO2, higher pulmonary artery and cerebral oxygen saturations, and lower mixed venous oxygen saturations (indicating less recirculation). With the test catheter, PaO2 levels ranged from 62 +/- 6 torr (8.3 +/- 0.8 kPa) to 112 +/- 12 torr (14.9 +/- 1.6 kPa), compared with 46 +/- 4 torr (6.1 +/- 0.5 kPa) to 59 +/- 2 torr (7.9 +/- 0.3 kPa) for the double-lumen, venovenous ECMO catheter (p < or = .001). These findings indicate that at all flow rates studied, less recirculation occurred with the test catheter than with the double-lumen, venovenous ECMO catheter.

CONCLUSIONS

These findings indicate that the redesign of the double-lumen, venovenous ECMO catheter, as outlined in this study, resulted in a significant reduction of recirculation, thereby resulting in a significant improvement in oxygenation while on venovenous ECMO. This newly designed catheter makes venovenous ECMO more effective, and represents a design that could be used for pediatric and/or adult ECMO.

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Authors+Show Affiliations

Raïs-Bahrami K
Department of Neonatology, Children's National Medical Center, Washington, DC 20010, USA.
Rivera O
No affiliation info available
Mikesell GT
No affiliation info available
Seale WR
No affiliation info available
Sell JE
No affiliation info available
Short BL
No affiliation info available

MeSH

AnimalsAnimals, NewbornEquipment DesignEvaluation Studies as TopicExtracorporeal Membrane OxygenationHemodynamicsOxygenProspective StudiesSheep

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

7587238

Citation

Raïs-Bahrami, K, et al. "Improved Oxygenation With Reduced Recirculation During Venovenous Extracorporeal Membrane Oxygenation: Evaluation of a Test Catheter." Critical Care Medicine, vol. 23, no. 10, 1995, pp. 1722-5.
Raïs-Bahrami K, Rivera O, Mikesell GT, et al. Improved oxygenation with reduced recirculation during venovenous extracorporeal membrane oxygenation: evaluation of a test catheter. Crit Care Med. 1995;23(10):1722-5.
Raïs-Bahrami, K., Rivera, O., Mikesell, G. T., Seale, W. R., Sell, J. E., & Short, B. L. (1995). Improved oxygenation with reduced recirculation during venovenous extracorporeal membrane oxygenation: evaluation of a test catheter. Critical Care Medicine, 23(10), 1722-5.
Raïs-Bahrami K, et al. Improved Oxygenation With Reduced Recirculation During Venovenous Extracorporeal Membrane Oxygenation: Evaluation of a Test Catheter. Crit Care Med. 1995;23(10):1722-5. PubMed PMID: 7587238.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Improved oxygenation with reduced recirculation during venovenous extracorporeal membrane oxygenation: evaluation of a test catheter. AU - Raïs-Bahrami,K, AU - Rivera,O, AU - Mikesell,G T, AU - Seale,W R, AU - Sell,J E, AU - Short,B L, PY - 1995/10/1/pubmed PY - 1995/10/1/medline PY - 1995/10/1/entrez SP - 1722 EP - 5 JF - Critical care medicine JO - Crit Care Med VL - 23 IS - 10 N2 - OBJECTIVE: To determine whether modifications of the original design of a double-lumen, venovenous, extracorporeal membrane oxygenation (ECMO) catheter would reduce recirculation and improve oxygenation during venovenous ECMO. DESIGN: Prospective, interventional study. SETTING: The animal research laboratory at The Children's National Medical Center. SUBJECTS: Six newborn lambs, 1 to 7 days old and weighing 4.7 +/- 0.9 kg. INTERVENTIONS: Animals were anesthetized, intubated and ventilated. The ductus arteriosus was ligated. Femoral artery and vein, cephalic jugular vein, and pulmonary artery catheters were placed. After systemic heparinization, the test catheter (with venous drainage holes moved away from the arterial return holes) was placed in the right internal jugular vein and advanced into the right atrium. The animal was placed on ECMO and stabilized, with the ventilator settings decreased to a peak inspiratory pressure of 15 cm H2O, peak positive end-expiratory pressure of 5 cm H2O, respiratory rate of 15 breaths/min, and an FIO2 of 0.21. ECMO flows were increased in 100-mL increments from 200 to 600 mL/min, with measurements taken 15 mins after each change. The test catheter was removed, the double-lumen, venovenous ECMO catheter was placed, and the studies were repeated. MEASUREMENTS AND MAIN RESULTS: Heart rate, mean arterial pressure, PaO2, jugular cerebral oxygen saturation, pulmonary artery oxygen saturation, mixed venous oxygen saturation, and postmembrane circuit pressures were measured at each study period. The test catheter improved oxygenation significantly, with higher systemic PaO2, higher pulmonary artery and cerebral oxygen saturations, and lower mixed venous oxygen saturations (indicating less recirculation). With the test catheter, PaO2 levels ranged from 62 +/- 6 torr (8.3 +/- 0.8 kPa) to 112 +/- 12 torr (14.9 +/- 1.6 kPa), compared with 46 +/- 4 torr (6.1 +/- 0.5 kPa) to 59 +/- 2 torr (7.9 +/- 0.3 kPa) for the double-lumen, venovenous ECMO catheter (p < or = .001). These findings indicate that at all flow rates studied, less recirculation occurred with the test catheter than with the double-lumen, venovenous ECMO catheter. CONCLUSIONS: These findings indicate that the redesign of the double-lumen, venovenous ECMO catheter, as outlined in this study, resulted in a significant reduction of recirculation, thereby resulting in a significant improvement in oxygenation while on venovenous ECMO. This newly designed catheter makes venovenous ECMO more effective, and represents a design that could be used for pediatric and/or adult ECMO. SN - 0090-3493 UR - https://www.unboundmedicine.com/medline/citation/7587238/Improved_oxygenation_with_reduced_recirculation_during_venovenous_extracorporeal_membrane_oxygenation:_evaluation_of_a_test_catheter_ L2 - https://dx.doi.org/10.1097/00003246-199510000-00017 DB - PRIME DP - Unbound Medicine ER -