TY - JOUR
T1 - Continuous monitoring of membrane lung carbon dioxide removal during ECMO
T2 - experimental testing of a new volumetric capnometer
AU - Montalti, Alice
AU - Belliato, Mirko
AU - Gelsomino, Sandro
AU - Nalon, Sandro
AU - Matteucci, Francesco
AU - Parise, Orlando
AU - de Jong, Monique
AU - Makhoul, Maged
AU - Johnson, Daniel M.
AU - Lorusso, Roberto
N1 - Funding Information:
M.B. designed the study protocol. A.M., O.P., S.G., S.N., M.M., F.M., M.D.J., D.M.J. and R.L. conducted the experiments. A.M. and O.P. carried out analysis. A.M., M.B., D.M.J. and R.L. contributed to drafting and writing of the manuscript. All authors read and approved the final manuscript. The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The animal and laboratory costs were partially funded by grants from ZEON Company, Tokyo, Japan, and Eurosets srl, Medolla, Italy.
Publisher Copyright:
© The Author(s) 2019.
PY - 2019/10
Y1 - 2019/10
N2 - Background: Extracorporeal membrane oxygenation constitutes a complex support modality, and accurate monitoring is required. An ideal monitoring system should promptly detect ECMO malfunctions and provide real-time information to optimize the patient-machine interactions. We tested a new volumetric capnometer which enables continuous monitoring of membrane lung carbon dioxide removal (V ' CO2ML), to help in estimating the oxygenator performance, in terms of CO2 removal and oxygenator dead space (VDsML). Methods: This study was conducted on nine pigs undergoing veno-arterial ECMO due to cardiogenic shock after induced acute myocardial infarction. The accuracy and reliability of the prototype of the volumetric capnometer (CO2RESET (TM), by Eurosets srl, Medolla, Italy) device was evaluated for V ' CO2ML and VDsML measurements by comparing the obtained measurements from the new device to a control capnometer with the sweep gas values. Measurements were taken at five different levels of gas flow/blood flow ratio (0.5-1.5). Agreement between the corresponding measurements was taken with the two methods. We expected that 95% of differences were between d - 1.96s and d + 1.96s. Results: In all, 120 coupled measurements from each device were obtained for the V ' CO2ML calculation and 40 for the VDsML. The new capnometer mean percentage bias (95% confidence interval limits of agreement) was 3.86% (12.07-4.35%) for V ' CO2ML and 2.62% (8.96-14.20%) for VDsML. A negative proportional bias for V ' CO2ML estimation with the new device was observed with a mean of 3.86% (12.07-4.35%). No correlations were found between differences in the coupled V ' CO2ML and VDsML measurements and the gas flow/blood flow ratio or temperature. Coupled measurements for V ' CO2ML showed strong correlation (r(s) = 0.991; p = 0.0005), as did VDsML calculations (r(s) = 0.973; p = 0.0005). Conclusion: The volumetric capnometer is reliable for continuous monitoring of CO2 removal by membrane lung and VDsML calculations. Further studies are necessary to confirm these data.
AB - Background: Extracorporeal membrane oxygenation constitutes a complex support modality, and accurate monitoring is required. An ideal monitoring system should promptly detect ECMO malfunctions and provide real-time information to optimize the patient-machine interactions. We tested a new volumetric capnometer which enables continuous monitoring of membrane lung carbon dioxide removal (V ' CO2ML), to help in estimating the oxygenator performance, in terms of CO2 removal and oxygenator dead space (VDsML). Methods: This study was conducted on nine pigs undergoing veno-arterial ECMO due to cardiogenic shock after induced acute myocardial infarction. The accuracy and reliability of the prototype of the volumetric capnometer (CO2RESET (TM), by Eurosets srl, Medolla, Italy) device was evaluated for V ' CO2ML and VDsML measurements by comparing the obtained measurements from the new device to a control capnometer with the sweep gas values. Measurements were taken at five different levels of gas flow/blood flow ratio (0.5-1.5). Agreement between the corresponding measurements was taken with the two methods. We expected that 95% of differences were between d - 1.96s and d + 1.96s. Results: In all, 120 coupled measurements from each device were obtained for the V ' CO2ML calculation and 40 for the VDsML. The new capnometer mean percentage bias (95% confidence interval limits of agreement) was 3.86% (12.07-4.35%) for V ' CO2ML and 2.62% (8.96-14.20%) for VDsML. A negative proportional bias for V ' CO2ML estimation with the new device was observed with a mean of 3.86% (12.07-4.35%). No correlations were found between differences in the coupled V ' CO2ML and VDsML measurements and the gas flow/blood flow ratio or temperature. Coupled measurements for V ' CO2ML showed strong correlation (r(s) = 0.991; p = 0.0005), as did VDsML calculations (r(s) = 0.973; p = 0.0005). Conclusion: The volumetric capnometer is reliable for continuous monitoring of CO2 removal by membrane lung and VDsML calculations. Further studies are necessary to confirm these data.
KW - capnometer
KW - membrane lung carbon dioxide removal
KW - extracorporeal membrane oxygenation monitoring
KW - oxygenator performance
KW - membrane lung function
KW - V ' CO2
KW - ECMO
KW - ECLS
KW - OXYGENATOR PERFORMANCE
U2 - 10.1177/0267659119833233
DO - 10.1177/0267659119833233
M3 - Article
C2 - 30868943
SN - 0267-6591
VL - 34
SP - 538
EP - 543
JO - Perfusion
JF - Perfusion
IS - 7
ER -