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. 2022 Apr 25;10(1):15.
doi: 10.1186/s40635-022-00442-x.

Lung perfusion during veno-venous extracorporeal membrane oxygenation in a model of hypoxemic respiratory failure

Pedro Vitale Mendes  1 , Marcelo Park  2 , Luciano Cesar Pontes de Azevedo  2 , Caio Cesar Araujo Morais  3 , Marcelo Brito Passos Amato  4 , Eduardo Leite Vieira Costa  4   5
Affiliations

Lung perfusion during veno-venous extracorporeal membrane oxygenation in a model of hypoxemic respiratory failure

Pedro Vitale Mendes et al. Intensive Care Med Exp. .

Abstract

Background: Veno-venous extracorporeal membrane oxygenation (ECMO) provides blood oxygenation and carbon dioxide removal in acute respiratory distress syndrome. However, during ECMO support, the native lungs still play an important role in gas exchange, functioning as a second oxygenator in series with ECMO. The hypoxic vasoconstriction mechanism diverts regional blood flow within the lungs away from regions with low oxygen levels, optimizing ventilation/perfusion matching. ECMO support has the potential to reduce this adaptive pulmonary response and worsen the ventilation/perfusion mismatch by raising venous oxygen partial pressure. Thus, the objective of this study was to evaluate the effect of ECMO on regional pulmonary perfusion and pulmonary hemodynamics during unilateral ventilation and posterior lung collapse.

Methods: Five Agroceres pigs were instrumented, monitored and submitted to ECMO. We used the Electrical Impedance Tomography (EIT) to evaluate lung ventilation and perfusion in all protocol steps. Effects of ECMO support on pulmonary hemodynamics and perfusion involving two different scenarios of ventilation/perfusion mismatch: (1) right-lung selective intubation inducing collapse of the normal left lung and (2) dorsal lung collapse after repeated lung lavage. Data including hemodynamics, respiratory, lung perfusion/ventilation, and laboratory data over time were analyzed with a mixed generalized model using the subjects as a random factor.

Results: The initiation of ECMO support provided a significant reduction in Mean Pulmonary Artery Pressure (PAPm) in both situations of ventilation/perfusion mismatch. However, distribution of lung perfusion did not change with the use of ECMO support.

Conclusions: We found that the use of ECMO support with consequent increase in venous oxygen pressure induced a significant drop in PAPm with no detectable effect on regional lung perfusion in different scenarios of ventilation/perfusion mismatch.

Keywords: Acute lung injury; Acute respiratory distress syndrome; Electrical impedance; Extracorporeal circulation; Perfusion; Ventilation–perfusion ratio.

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Conflict of interest statement

The authors received a donation of Biocube systems from NiproBrasil from Brazil. The authors declare that they have no other competing interests.

Figures

Fig. 1
Fig. 1
Flowchart showing the stages of the experiment. W/O denotes without, ECMO denotes extracorporeal membrane oxygenation
Fig. 2
Fig. 2
Left lung ventilation in % of lung ventilation (top left); left lung perfusion in % of pulmonary blood flow (top right); mean pulmonary artery pressure (bottom left); pulmonary shunt (bottom right). Gas flow OFF denotes no ECMO support due to the absence of gas flow. Gas flow ON denotes the initiation of ECMO support
Fig. 3
Fig. 3
Posterior lung ventilation in % of lung ventilation (top left); posterior lung perfusion in % of pulmonary blood flow (top right); mean pulmonary artery pressure (bottom left); pulmonary shunt (bottom right). Gas flow OFF denotes no ECMO support due the absence of gas flow. Gas flow ON denotes the initiation of ECMO support
See this image and copyright information in PMC

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