'Goal-directed extracorporeal circulation: transferring the knowledge and experience from daily cardiac surgery to extracorporeal membrane oxygenation'

I. Condello*, G. Santarpino, G. Nasso, M. Moscarelli, G. Speziale, R. Lorusso

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review

Abstract

Metabolism management plays an essential role in extracorporeal technologies. There are different metabolic management devices integrated to extracorporeal devices; the most commonly used and accepted metabolic target in adult patients is indexed oxygen delivery (280 mL/min/m(2)) and cardiac index (2.4 L/min/m(2)), which can be managed independently or according to other metabolic parameters. Extracorporeal membrane oxygenation (ECMO) is a temporary form of life support providing a prolonged biventricular circulatory and pulmonary support for patients experiencing both pulmonary and cardiac failure unresponsive to conventional therapy. The goal-directed perfusion initiative during cardiopulmonary bypass (CPB) reduced the incidence of acute kidney injury after cardiac surgery. On the basis of the available literature, the identified goals to achieve during CPB include maintenance of oxygen delivery > 300 mL O-2/min/m(2) and reduction in vasopressor use. ECMO and CPB are conceptually similar but differ in many aspects and finality; in particular, they differ in the scientific evidence for metabolic management nadirs. As for CPB, predictive target parameters have been found and consolidated, particularly in terms of acute renal injury and the prevention of anaerobic metabolism, while for ECMO management, a blurred path remains. In this context, we review the strategies for optimal goal-directed therapy during CPB and ECMO, trying to transfer the knowledge and experience from daily cardiac surgery to veno-arterial ECMO.
Original languageEnglish
Article number02676591211063826
Pages (from-to)449-454
Number of pages6
JournalPerfusion
Volume38
Issue number3
Early online date19 Dec 2021
DOIs
Publication statusPublished - Apr 2023

Keywords

  • goal-directed therapy
  • goal-directed perfusion
  • extracorporeal membrane oxygenation
  • cardiopulmonary bypass
  • acute kidney
  • injuries
  • end-organ protection
  • ACUTE KIDNEY INJURY
  • CARDIOPULMONARY BYPASS
  • LOWEST HEMATOCRIT
  • PERFUSION
  • DELIVERY
  • HEMODILUTION
  • ASSOCIATION
  • SYSTEM
  • ADULT
  • INDEX

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