PMID- 27271548
OWN - NLM
STAT- MEDLINE
DCOM- 20170502
LR  - 20201209
IS  - 1525-1489 (Electronic)
IS  - 0885-0666 (Linking)
VI  - 31
IP  - 8
DP  - 2016 Sep
TI  - Low Blood Arterial Oxygenation During Venovenous Extracorporeal Membrane 
      Oxygenation: Proposal for a Rational Algorithm-Based Management.
PG  - 553-60
LID - 10.1177/0885066616649134 [doi]
AB  - PURPOSE: Venovenous extracorporeal membrane oxygenation (VV-ECMO) is a 
      therapeutic option in the management of the most severe forms of acute 
      respiratory distress syndrome. Oxygenation during VV-ECMO depends on many 
      parameters, and its management is complex. The management of ECMO is still not 
      completely codified. The aim of this study was to rationalize the management of 
      hypoxemia during VV-ECMO. METHODS: To build a comprehensive flow diagram for 
      management of hypoxemia during VV-ECMO, we considered (1) relationship between O2 
      arterial saturation and its determinants; (2) analysis of physiopathology of 
      oxygenation under VV-ECMO; and (3) main guidelines and recommendations 
      recapitulated in troubleshooting charts. RESULTS: We propose a stepwise approach 
      that could guide specific intervention to improve oxygenation during VV-ECMO. The 
      first step is to obtain adequate pump flow, the main determinant of oxygenation, 
      by eliminating a mechanical problem or inadequate venous drainage. Second, if 
      hypoxemia persists, algorithm considers multiple reasons for inadequate 
      oxygenation, namely: (1) excessive recirculation, (2) excessive cardiac output 
      (decrease of ratio pump flow/cardiac output), (3) decrease in SvO2 (oxygen 
      saturation in mixed venous blood), (4) malfunction of oxygenator, and (5) 
      deterioration of residual lung function. Finally, for each modification of 
      oxygenation parameters, specific measures are proposed to restore an adequate 
      oxygenation by extracorporeal membrane oxygenation. CONCLUSION: If hypoxemia 
      occurs during VV-ECMO, collecting oxygenation parameters and a clear step-by-step 
      algorithm could guide specific intervention to improve oxygenation. This flow 
      diagram is in accordance with current recommendations recapitulated in guidelines 
      or troubleshooting chart but more accurate and complete. Although rational and 
      appealing, it remains to be tested together with a number of still unsolved 
      issues.
CI  - (c) The Author(s) 2016.
FAU - Messai, Elmi
AU  - Messai E
AD  - Service de reanimation, Centre Hospitalier de Cholet, Cholet, France 
      messaielmi@gmail.com.
FAU - Bouguerra, Abdesselam
AU  - Bouguerra A
AD  - Departement de Physique, Universite de Souk Ahras, Souk Ahras, Algeria.
FAU - Guarracino, Fabio
AU  - Guarracino F
AD  - Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliero 
      Universitaria Pisana, Pisa, Italy.
FAU - Bonacchi, Massimo
AU  - Bonacchi M
AD  - Cardiac Surgery, Experimental and Clinical Medicine Department, University of 
      Florence, Firenze, Italy.
LA  - eng
PT  - Journal Article
DEP - 20160605
PL  - United States
TA  - J Intensive Care Med
JT  - Journal of intensive care medicine
JID - 8610344
RN  - S88TT14065 (Oxygen)
SB  - IM
MH  - *Algorithms
MH  - Cardiac Output
MH  - *Extracorporeal Membrane Oxygenation/adverse effects
MH  - Humans
MH  - Hypoxia/etiology/physiopathology/*therapy
MH  - Lung/physiopathology
MH  - Oxygen/blood
MH  - Oxygen Consumption
MH  - Respiratory Distress Syndrome/physiopathology/*therapy
OTO - NOTNLM
OT  - acute respiratory distress syndrome
OT  - extracorporeal membrane oxygenation
OT  - oxygenation
OT  - recirculation
EDAT- 2016/06/09 06:00
MHDA- 2017/05/04 06:00
CRDT- 2016/06/09 06:00
PHST- 2016/03/01 00:00 [received]
PHST- 2016/04/20 00:00 [accepted]
PHST- 2016/06/09 06:00 [entrez]
PHST- 2016/06/09 06:00 [pubmed]
PHST- 2017/05/04 06:00 [medline]
AID - 0885066616649134 [pii]
AID - 10.1177/0885066616649134 [doi]
PST - ppublish
SO  - J Intensive Care Med. 2016 Sep;31(8):553-60. doi: 10.1177/0885066616649134. Epub 
      2016 Jun 5.