Letter by Giani et al Regarding Article, “Exposure to Arterial Hyperoxia During Extracorporeal Membrane Oxygenator Support and Mortality in Patients With Cardiogenic Shock”

Giani, Marco; Pozzi, Matteo; Rezoagli, Emanuele

doi:10.1161/circheartfailure.123.010701

Circ: Heart Failure

2023

DOI: 10.1161/circheartfailure.123.010701

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Letter by Giani et al Regarding Article, “Exposure to Arterial Hyperoxia During Extracorporeal Membrane Oxygenator Support and Mortality in Patients With Cardiogenic Shock”

Marco Giani

Matteo Pozzi

Emanuele Rezoagli

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Cited by 3 publications

(2 citation statements)

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“…) who showed that an increased time to prone positioning (PP) during venovenous extracorporeal membrane oxygenation (V-V ECMO) was independently associated with a lower probability of being discharged alive from the intensive care unit at 90 days. However, we have several concerns about the study by Giani et al (1).…”

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confidence: 95%

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Controversial Efficacy of Early Timing of Prone Positioning for Severe Acute Respiratory Distress Syndrome During Venovenous Extracorporeal Membrane Oxygenation

Inagawa

Ohshimo

Shime

2023

Critical Care Medicine

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“…Marco Giani, MD 1,2 Emanuele Rezoagli, MD, PhD 1,2 The authors reply: W e thank Inagawa et al (1) for their interest and comments on our recently published article (2) in Critical Care Medicine.…”

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confidence: 99%

Controversial Efficacy of Early Timing of Prone Positioning for Severe Acute Respiratory Distress Syndrome During Venovenous Extracorporeal Membrane Oxygenation

Inagawa

Ohshimo

Shime

2023

Critical Care Medicine

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Hyperoxia and VA-ECMO Outcomes: Getting to the Heart of the Problem

Ortoleva

2024

Journal of Cardiothoracic and Vascular Anesthesia

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Oxygenation During Venoarterial Extracorporeal Membrane Oxygenation: Physiology, Current Evidence, and a Pragmatic Approach to Oxygen Titration

Premraj,

Brown,

Fraser

et al. 2023

Critical Care Medicine

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OBJECTIVES: This review aims to: 1) identify the key circuit and patient factors affecting systemic oxygenation, 2) summarize the literature reporting the association between hyperoxia and patient outcomes, and 3) provide a pragmatic approach to oxygen titration, in patients undergoing peripheral venoarterial extracorporeal membrane oxygenation (ECMO). DATA SOURCES: Searches were performed using PubMed, SCOPUS, Medline, and Google Scholar. STUDY SELECTION: All observational and interventional studies investigating the association between hyperoxia, and clinical outcomes were included, as well as guidelines from the Extracorporeal Life Support Organization. DATA EXTRACTION: Data from relevant literature was extracted, summarized, and integrated into a concise narrative review. For ease of reference a summary of relevant studies was also produced. DATA SYNTHESIS: The extracorporeal circuit and the native cardiorespiratory circuit both contribute to systemic oxygenation during venoarterial ECMO. The ECMO circuit’s contribution to systemic oxygenation is, in practice, largely determined by the ECMO blood flow, whereas the native component of systemic oxygenation derives from native cardiac output and residual respiratory function. Interactions between ECMO outflow and native cardiac output (as in differential hypoxia), the presence of respiratory support, and physiologic parameters affecting blood oxygen carriage also modulate overall oxygen exposure during venoarterial ECMO. Physiologically those requiring venoarterial ECMO are prone to hyperoxia. Hyperoxia has a variety of definitions, most commonly Pao 2 greater than 150 mm Hg. Severe hypoxia (Pao 2 > 300 mm Hg) is common, seen in 20%. Early severe hyperoxia, as well as cumulative hyperoxia exposure was associated with in-hospital mortality, even after adjustment for disease severity in both venoarterial ECMO and extracorporeal cardiopulmonary resuscitation. A pragmatic approach to oxygenation during peripheral venoarterial ECMO involves targeting a right radial oxygen saturation target of 94–98%, and in selected patients, titration of the fraction of oxygen in the mixture via the air-oxygen blender to target postoxygenator Pao 2 of 150–300 mm Hg. CONCLUSIONS: Hyperoxia results from a range of ECMO circuit and patient-related factors. It is common during peripheral venoarterial ECMO, and its presence is associated with poor outcome. A pragmatic approach that avoids hyperoxia, while also preventing hypoxia has been described for patients receiving peripheral venoarterial ECMO.

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Letter by Giani et al Regarding Article, “Exposure to Arterial Hyperoxia During Extracorporeal Membrane Oxygenator Support and Mortality in Patients With Cardiogenic Shock”

Cited by 3 publications

References 4 publications

Controversial Efficacy of Early Timing of Prone Positioning for Severe Acute Respiratory Distress Syndrome During Venovenous Extracorporeal Membrane Oxygenation

Controversial Efficacy of Early Timing of Prone Positioning for Severe Acute Respiratory Distress Syndrome During Venovenous Extracorporeal Membrane Oxygenation

Hyperoxia and VA-ECMO Outcomes: Getting to the Heart of the Problem

Oxygenation During Venoarterial Extracorporeal Membrane Oxygenation: Physiology, Current Evidence, and a Pragmatic Approach to Oxygen Titration

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