Article in Press: Practice characteristics of Emergency Department extracorporeal cardiopulmonary resuscitation (eCPR) programs in the United States: The current state of the art of Emergency Department extracorporeal membrane oxygenation (ED ECMO)
Practice characteristics of Emergency Department extracorporeal cardiopulmonary resuscitation (eCPR) programs in the United States: The current state of the art of Emergency Department extracorporeal membrane oxygenation (ED ECMO)
Joseph E. Tonna,∗, Nicholas J. Johnson, John Greenwood, David F. Gaieskie, Zachary Shinar, Joseph M. Bellezzo, Lance Becker, Atman P. Shah, Scott T. Youngquist, Michael P. Mallin, James Franklin Fair III , Kyle J. Gunnerson, Cindy Weng, Stephen McKellar, for the Extracorporeal REsuscitation ConsorTium (ERECT) Research Group
What kind of PaCO2-values are usually seen during ecpr? Can PaCO2 be titrated or is it just left to be what it happens to sit at when PaO2 and perfusion pressure are good?
Juuso, Thanks for the question. PaCO2 is measured using a typical arterial blood gas, preferably from the right radial artery. We want the PaCO2 to be in the normal range (35-45). You would increase or decrease your PaCO2 by adjusting your sweep gas RATE. The “sweep gas” is the oxygen source that is attached to your oxygenator. In ECPR cases, that is typically 100% O2 coming from an oxygen bottle or the wall oxygen source. The “sweep gas rate” is the RATE the oxygen is delivered to the oxygenator and is measured in L/min. By example, If you have a non-ECMO patient on “4 liters/min of nasal cannula oxygen”, as measured on the wall oxygen flow meter, and you disconnect the nasal cannula and attach that same oxygen tubing to an ECMO Oxygenator, its now called “Sweep Gas”. simple. Adjusting PaCO2 via an ECMO oxygenator is the same principle as adjusting the PaCO2 by ventilation. Increase the ‘sweep gas rate’ is the same is increasing ventilation on a ventilator and the PaCO2 will go down. And vice versa. Simple.