Coronary arterial perfusion during venoarterial extracorporeal membrane oxygenation Junji Kato, MD, Takahiko Seo, MD, PhD, Hisami Ando, MD, PhD, Hiroyuki.

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Presentation transcript:

Coronary arterial perfusion during venoarterial extracorporeal membrane oxygenation Junji Kato, MD, Takahiko Seo, MD, PhD, Hisami Ando, MD, PhD, Hiroyuki Takagi, MD, PhD, Takahiro Ito, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 111, Issue 3, Pages 630-636 (March 1996) DOI: 10.1016/S0022-5223(96)70315-X Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 1 Schematic diagram of the VA-ECMO circuit and experimental model. Note the placement of the electromagnetic flow probe on the coronary artery and the cannulation sites for hemodynamic measurements. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 630-636DOI: (10.1016/S0022-5223(96)70315-X) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 2 CAF as a function of bypass flow. Ventilation settings were reduced to 10 cm H2O peak inspiratory pressure and 10 breaths/min respiratory rate between period before VA-ECMO (pre) and the initiation of VA-ECMO. CAF increased significantly with reduced ventilator settings and decreased significantly shortly after the initiation of ECMO. CAF continued to fall with increases in the ECMO flow. As the ECMO flow was decreased from the maximum of 100 ml · min-1 · kg-1 to 20 ml · min-1 · kg-1, CAF increased to the same level as before VA-ECMO. gLV, Grams of left ventricle, wet weight; SD, standard deviation. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 630-636DOI: (10.1016/S0022-5223(96)70315-X) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 3 Blood gas analysis during VA-ECMO. Pao2 and arterial carbon dioxide tension (Paco2) were measured in blood obtained from the femoral artery (FA), ascending aorta (Ao), and left ventricle (LV). A low Pao2 before ECMO (pre) in the FA resulted from reduced ventilator settings. Pao2 in the FA increased significantly with ECMO flows greater than 60 ml · min-1 · kg-1. There were no significant changes in Pao2 in the LV or Ao. The disparity in Pao2 among the different sites became more prominent as the ECMO flow was increased to 100 ml · min-1 · kg-1. There were no significant changes in Paco2 at the different ECMO flow rates or at the different sites. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 630-636DOI: (10.1016/S0022-5223(96)70315-X) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 4 Coronary resistance as a function of bypass flow. The coronary resistance decreased with reduced ventilator settings and increased with increases in bypass flow. The difference in coronary resistance between the peak ECMO flow (100 ml · min-1 · kg-1) and minimal ECMO flow (20 ml · min-1 · kg-1) was statistically significant (p < 0.01). The coronary resistance returned to baseline as the bypass flow was decreased. gLV, Grams of left ventricle, wet weight; SD, standard deviation. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 630-636DOI: (10.1016/S0022-5223(96)70315-X) Copyright © 1996 Mosby, Inc. Terms and Conditions