PMID- 34075067 OWN - NLM STAT- MEDLINE DCOM- 20211103 LR - 20211103 IS - 2045-2322 (Electronic) IS - 2045-2322 (Linking) VI - 11 IP - 1 DP - 2021 Jun 1 TI - Estimating cardiac output based on gas exchange during veno-arterial extracorporeal membrane oxygenation in a simulation study using paediatric oxygenators. PG - 11528 LID - 10.1038/s41598-021-90747-w [doi] LID - 11528 AB - Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) therapy is a rescue strategy for severe cardiopulmonary failure. The estimation of cardiac output during VA-ECMO is challenging. A lung circuit ([Formula: see text](Lung)) and an ECMO circuit ([Formula: see text](ECMO)) with oxygenators for CO(2) removal ([Formula: see text]CO(2)) and O(2) uptake ([Formula: see text]O(2)) simulated the setting of VA-ECMO with varying ventilation/perfusion ([Formula: see text]/[Formula: see text]) ratios and shunt. A metabolic chamber with a CO(2)/N(2) blend simulated [Formula: see text]CO(2) and [Formula: see text]O(2). [Formula: see text] (Lung) was estimated with a modified Fick principle: [Formula: see text](Lung) = [Formula: see text](ECMO) x ([Formula: see text] CO(2) or [Formula: see text]O(2Lung))/([Formula: see text]CO(2) or [Formula: see text]O(2ECMO)). A normalization procedure corrected [Formula: see text]CO(2) values for a [Formula: see text]/[Formula: see text] of 1. Method agreement was evaluated by Bland-Altman analysis. Calculated [Formula: see text](Lung) using gaseous [Formula: see text]CO(2) and [Formula: see text]O(2) correlated well with measured [Formula: see text](Lung) with a bias of 103 ml/min [- 268 to 185] ml/min; Limits of Agreement: - 306 ml/min [- 241 to - 877 ml/min] to 512 ml/min [447 to 610 ml/min], r(2) 0.85 [0.79-0.88]). Blood measurements of [Formula: see text]CO(2) showed an increased bias (- 260 ml/min [- 1503 to 982] ml/min), clinically not applicable. Shunt and [Formula: see text]/[Formula: see text] mismatch decreased the agreement of methods significantly. This in-vitro simulation shows that [Formula: see text]CO(2) and [Formula: see text]O(2) in steady-state conditions allow for clinically applicable calculations of [Formula: see text](Lung) during VA-ECMO therapy. FAU - Bachmann, Kaspar Felix AU - Bachmann KF AD - Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. kasparfelix.bachmann@gmail.com. AD - Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. kasparfelix.bachmann@gmail.com. FAU - Vasireddy, Rakesh AU - Vasireddy R AD - Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. FAU - Heinisch, Paul Philipp AU - Heinisch PP AD - Department of Cardiac and Vascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. AD - Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universitat Munchen, Munich, Germany. FAU - Jenni, Hansjorg AU - Jenni H AD - Department of Cardiac and Vascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. FAU - Vogt, Andreas AU - Vogt A AD - Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. FAU - Berger, David AU - Berger D AD - Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20210601 PL - England TA - Sci Rep JT - Scientific reports JID - 101563288 RN - 142M471B3J (Carbon Dioxide) RN - S88TT14065 (Oxygen) SB - IM MH - Carbon Dioxide/*blood MH - Child MH - *Extracorporeal Membrane Oxygenation MH - Humans MH - *Models, Cardiovascular MH - Oxygen/*blood MH - *Oxygen Consumption PMC - PMC8169686 COIS- Dr. Vogt, Dr. Heinisch, H. Jenni and R. Vassiredy report no conflict of interest. Dr. Bachmann and Dr. Berger have filed a patent related to the manuscripts content. The Department of Intensive Care Medicine at the Inselspital has, or has had in the past, research contracts with Abionic SA, AVA AG, CSEM SA, Cube Dx GmbH, Cyto Sorbents Europe GmbH, Edwards Lifesciences LLC, GE Healthcare, ImaCor Inc., MedImmune LLC, Orion Corporation, Phagenesis Ltd. and research & development/consulting contracts with Edwards Lifesciences LLC, Nestec SA, Wyss Zurich. The money was paid into a departmental fund; Dr Berger and the other authors received no personal financial gain. The Department of Intensive Care Medicine has received unrestricted educational grants from the following organizations for organizing a quarterly postgraduate educational symposium, the Berner Forum for Intensive Care (until 2015): Abbott AG, Anandic Medical Systems, Astellas, AstraZeneca, Bard Medica SA, Baxter, B | Braun, CSL Behring, Covidien, Fresenius Kabi, GSK, Lilly, Maquet, MSD, Novartis, Nycomed, Orion Pharma, Pfizer, Pierre Fabre Pharma AG (formerly known as RobaPharm). The Department of Intensive Care Medicine has received unrestricted educational grants from the following organizations for organizing bi-annual postgraduate courses in the fields of critical care ultrasound, management of ECMO and mechanical ventilation: Abbott AG, Anandic Medical Systems, Bard Medica SA., Bracco, Drager Schweiz AG, Edwards Lifesciences AG, Fresenius Kabi (Schweiz) AG, Getinge Group Maquet AG, Hamilton Medical AG, Pierre Fabre Pharma AG (formerly known as RobaPharm), PanGas AG Healthcare, Pfizer AG, Orion Pharma, Teleflex Medical GmbH. EDAT- 2021/06/03 06:00 MHDA- 2021/11/04 06:00 PMCR- 2021/06/01 CRDT- 2021/06/02 06:13 PHST- 2020/09/23 00:00 [received] PHST- 2021/05/17 00:00 [accepted] PHST- 2021/06/02 06:13 [entrez] PHST- 2021/06/03 06:00 [pubmed] PHST- 2021/11/04 06:00 [medline] PHST- 2021/06/01 00:00 [pmc-release] AID - 10.1038/s41598-021-90747-w [pii] AID - 90747 [pii] AID - 10.1038/s41598-021-90747-w [doi] PST - epublish SO - Sci Rep. 2021 Jun 1;11(1):11528. doi: 10.1038/s41598-021-90747-w.