Cerebral Tissue Oxygen Saturation During Percutaneous Cardiopulmonary Support in a Canine Model of Respiratory Failure

Wada, Hideichi; Watari, Masanobu; Sueda, Taijiro; Kochi, Kazuhiro; Shibamura, Hidenori; Imai, Kyoichi; Fukunaga, Shintaro; Orihashi, Kazumasa; Matsuura, Yuichiro

doi:10.1046/j.1525-1594.2000.06601.x

Cited by 15 publications

(13 citation statements)

References 21 publications

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Section: Introductionmentioning

confidence: 99%

“…Due to continuous tissue oxygen consumption, FDH leads to oxygen deprivation and extremely low arterial saturation (S a O 2 ) in the upper body with subsequent risk of global cerebral and myocardial hypoxia. 7,8 The aim of this article is to elucidate the impact of different cannulation approaches to the genesis, diagnosis, and management of FDH during VA ECMO.…”

Section: Introductionmentioning

confidence: 99%

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Differential hypoxemia during venoarterial extracorporeal membrane oxygenation

et al. 2019

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Venoarterial extracorporeal membrane oxygenation, indicated for severe cardio-respiratory failure, may result in anatomic regional differences in oxygen saturation. This depends on cannulation, hemodynamic state, and severity of respiratory failure. Differential hypoxemia, often discrete, may cause clinical problems in peripheral femoro-femoral venoarterial extracorporeal membrane oxygenation, when the upper body is perfused with low saturated blood from the heart and the lower body with well-oxygenated extracorporeal membrane oxygenation blood. The key is to diagnose and manage fulminant differential hypoxemia, that is, a state that may develop where the upper body is deprived of oxygen. We summarize physiology, assessment of diagnosis, and management of fulminant differential hypoxemia during venoarterial extracorporeal membrane oxygenation. A possible solution is implantation of an additional jugular venous return cannula. In this article, we propose an even better solution, to drain the venous blood from the superior vena cava. Drainage from the superior vena cava provides superiority to venovenoarterial configuration in terms of physiological rationale, efficiency, safety, and simplicity in clinical circuit design.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Differential hypoxemia during venoarterial extracorporeal membrane oxygenation

et al. 2019

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“…It has been reported that differential hypoxia could cause insufficient oxygen supply to the vital organs, such as the brain and heart [ 17 , 18 ]. To avoid the risk of differential hypoxia, a number of critical care professionals recommend that the clinical application of VA ECMO is best avoided in ARDS patients [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

Superior vena cava drainage improves upper body oxygenation during veno-arterial extracorporeal membrane oxygenation in sheep

Hou

Yang

et al. 2015

Crit Care

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IntroductionDifferential hypoxia is a pivotal problem in patients with femoral veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) support. Despite recognition of differential hypoxia and attempts to deliver more oxygenated blood to the upper body, the mechanism of differential hypoxia as well as prevention strategies have not been well investigated.MethodsWe used a sheep model of acute respiratory failure that was supported with femoral VA ECMO from the inferior vena cava to the femoral artery (IVC-FA), ECMO from the superior vena cava to the FA (SVC-FA), ECMO from the IVC to the carotid artery (IVC-CA) and ECMO with an additional return cannula to the internal jugular vein based on the femoral VA ECMO (FA-IJV). Angiography and blood gas analyses were performed.ResultsWith IVC-FA, blood oxygen saturation (SO2) of the IVC (83.6 ± 0.8%) was higher than that of the SVC (40.3 ± 1.0%). Oxygen-rich blood was drained back to the ECMO circuit and poorly oxygenated blood in the SVC entered the right atrium (RA). SVC-FA achieved oxygen-rich blood return from the IVC to the RA without shifting the arterial cannulation. Subsequently, SO2 of the SVC and the pulmonary artery increased (70.4 ± 1.0% and 73.4 ± 1.1%, respectively). Compared with IVC-FA, a lesser difference in venous oxygen return and attenuated differential hypoxia were observed with IVC-CA and FA-IJV.ConclusionsDifferential venous oxygen return is a key factor in the etiology of differential hypoxia in VA ECMO. With knowledge of this mechanism, we can apply better cannula configurations in clinical practice.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-015-0791-2) contains supplementary material, which is available to authorized users.

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“…Differential hypoxia has been reported which could cause insufficient oxygen supply to vital organs, such as the brain and heart, in respiratory dysfunction patients with femoral VA ECMO (from the inferior vena cava to the femoral artery, IVC-FA) [ 28 ]. If the femoral artery cannulation is chosen, oxygenated blood flow will retrograde up the descending aorta and into ascending aorta, to supply the coronary arteries and cerebral vessels.…”

Section: Clinical Viewsmentioning

confidence: 99%

Extracorporeal Membrane Oxygenation as a Bridge for Heart Failure and Cardiogenic Shock

Zhong

Wang

Hou

2016

BioMed Research International

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Heart failure (HF) can be defined as cardiac structural or functional abnormality leading to a series of symptoms due to deficiency of oxygen delivery. In the clinical practice, acute heart failure (AHF) is usually performed as cardiogenic shock (CS), pulmonary edema, and single or double ventricle congestive heart failure. CS refers to depressed or insufficient cardiac output (CO) attributable to myocardial infarction, fulminant myocarditis, acute circulatory failure attributable to intractable arrhythmias or the exacerbation of chronic heart failure, postcardiotomy low CO syndrome, and so forth. Epidemiological studies have shown that CS has higher in-hospital mortality in patients with AHF. Besides, we call the induced, sustained circulatory failure even after administration of high doses of inotropes and vasopressors refractory cardiogenic shock. In handling these cases, mechanical circulatory support devices are usually needed. In this review, we discuss the current application status and clinical points in utilizing extracorporeal membrane oxygenation (ECMO).

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Cerebral Tissue Oxygen Saturation During Percutaneous Cardiopulmonary Support in a Canine Model of Respiratory Failure

Cited by 15 publications

References 21 publications

Differential hypoxemia during venoarterial extracorporeal membrane oxygenation

Differential hypoxemia during venoarterial extracorporeal membrane oxygenation

Superior vena cava drainage improves upper body oxygenation during veno-arterial extracorporeal membrane oxygenation in sheep

Extracorporeal Membrane Oxygenation as a Bridge for Heart Failure and Cardiogenic Shock

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