PMID- 21397257
OWN - NLM
STAT- MEDLINE
DCOM- 20111207
LR  - 20201209
IS  - 1097-685X (Electronic)
IS  - 0022-5223 (Linking)
VI  - 142
IP  - 5
DP  - 2011 Nov
TI  - A novel strategy to improve systemic oxygenation in venovenous extracorporeal 
      membrane oxygenation: the "chi-configuration".
PG  - 1197-204
LID - 10.1016/j.jtcvs.2011.01.046 [doi]
AB  - BACKGROUND: Venovenous extracorporeal membrane oxygenation (VV-ECMO) is used in 
      refractory acute respiratory distress syndrome where lung recovery is the primary 
      goal. For its achievement, adequate extracorporeal blood flow and a maximal 
      separation between oxygenated (inflow) and deoxygenated (outflow) blood flow are 
      essential for reducing the recirculation phenomenon. We introduce the 
      chi-configuration, a new cannulation strategy for VV-ECMO. PATIENTS AND METHODS: We 
      report our experience with 30 VV-ECMO consecutive patients: in 16 patients (group 
      NS) we applied the chi-configuration, which consists of a particular right atrial 
      cannula arrangement and a self-made modified inflow cannula, consisting of an 
      outflow multihole venous cannula that was inserted percutaneously through the 
      right femoral vein, into the right atrium, just below on the superior vena cava, 
      and a self-made modified curved inflow cannula (inserted percutaneously through 
      the right internal jugular vein) that, in its terminal segment, permitted the tip 
      to be positioned close to the tricuspid valve. In 14 patients (group C) we 
      applied the standard femoro-jugular VV-ECMO 2-cannula setting. In both groups, 
      efficacy of blood oxygenation was obtained by gas-blood analysis, by blood 
      samples obtained at arterial, central venous, and pulmonary artery lines, and by 
      ECMO inflow and outflow lines. The recirculation fraction was obtained by a 
      specific bedside formula. RESULTS: No differences were noted between groups 
      regarding the pre-ECMO patient characteristics. No complications during 
      cannulation were recorded. In group NS, on-ECMO time, post-ECMO mechanical 
      ventilation time, and ECMO overall results were significantly better than in 
      group C. During high-flow VV-ECMO, pulmonary and systemic arterial oxygen 
      saturation and arterial oxygen tension were significantly higher in group NS, and 
      blood recirculation fraction was significantly lower. CONCLUSIONS: Our data 
      indicate that chi-configuration can be safe, feasible, and more effective than 
      conventional VV-ECMO. It permits near complete drainage of the desaturated blood 
      and a preferential oxygenated blood inflow toward the tricuspid valve, resulting 
      in a significant reduction of recirculation, thereby improving the patient's 
      oxygenation. Our innovative strategy reduces on-ECMO and post-ECMO mechanical 
      ventilation time, gives a faster and better pulmonary recovery, improves 
      survival, and can reduce hospital costs.
CI  - Copyright (c) 2011 The American Association for Thoracic Surgery. Published by 
      Mosby, Inc. All rights reserved.
FAU - Bonacchi, Massimo
AU  - Bonacchi M
AD  - Cardiac Surgery, Medical and Surgical Critical Care Department, University of 
      Florence, Firenze, Italy. mbonacchi@unifi.it
FAU - Harmelin, Guy
AU  - Harmelin G
FAU - Peris, Adriano
AU  - Peris A
FAU - Sani, Guido
AU  - Sani G
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Video-Audio Media
DEP - 20110312
PL  - United States
TA  - J Thorac Cardiovasc Surg
JT  - The Journal of thoracic and cardiovascular surgery
JID - 0376343
RN  - S88TT14065 (Oxygen)
SB  - IM
CIN - J Thorac Cardiovasc Surg. 2012 Apr;143(4):993-4; author reply 994-5. PMID: 
      22424528
MH  - Adult
MH  - Aged
MH  - Blood Gas Analysis
MH  - Chi-Square Distribution
MH  - Equipment Design
MH  - Extracorporeal Membrane Oxygenation/adverse effects/instrumentation/*methods
MH  - Feasibility Studies
MH  - Female
MH  - Hemodynamics
MH  - Humans
MH  - Italy
MH  - Male
MH  - Middle Aged
MH  - Oxygen/*blood
MH  - *Respiration, Artificial
MH  - Respiratory Distress Syndrome/blood/physiopathology/*therapy
MH  - Time Factors
MH  - Treatment Outcome
MH  - Young Adult
EDAT- 2011/03/15 06:00
MHDA- 2011/12/13 00:00
CRDT- 2011/03/15 06:00
PHST- 2010/10/04 00:00 [received]
PHST- 2010/12/26 00:00 [revised]
PHST- 2011/01/24 00:00 [accepted]
PHST- 2011/03/15 06:00 [entrez]
PHST- 2011/03/15 06:00 [pubmed]
PHST- 2011/12/13 00:00 [medline]
AID - S0022-5223(11)00122-X [pii]
AID - 10.1016/j.jtcvs.2011.01.046 [doi]
PST - ppublish
SO  - J Thorac Cardiovasc Surg. 2011 Nov;142(5):1197-204. doi: 
      10.1016/j.jtcvs.2011.01.046. Epub 2011 Mar 12.