| Autor: |
Kalra, Andrew, Shou, Benjamin L., Zhao, David, Wilcox, Christopher, Keller, Steven P., Kim, Bo Soo, Whitman, Glenn J.R., Cho, Sung-Min |
| Zdroj: |
Annals of Thoracic Surgery; Jun2024, Vol. 117 Issue 6, p1221-1228, 8p |
| Abstrakt: |
Cannulation strategy, vasopressors, and hemolysis are important physiological factors that influence hemodynamics in extracorporeal membrane oxygenation (ECMO). We hypothesized these factors influence the discrepancy between oxygen saturation measured by pulse oximetry (Sp o 2) and arterial blood gas (Sa o 2) in patients on ECMO. We retrospectively analyzed adults (aged ≥18 years) on venoarterial or venovenous ECMO at a tertiary academic ECMO center. Sp o 2 −Sa o 2 pairs with oxygen saturation ≥70% and measured within 10 minutes were included. Occult hypoxemia was defined as Sa o 2 ≤88% with a time-matched Sp o 2 ≥92%. Adjusted linear mixed-effects modeling was used to assess the Sp o 2 −Sa o 2 discrepancy with preselected demographics and time-matched laboratory variables. Vasopressor use was quantified by vasopressor dose equivalences. Of 139 venoarterial-ECMO and 88 venovenous-ECMO patients, we examined 20,053 Sp o 2 −Sa o 2 pairs. The Sp o 2 −Sa o 2 discrepancy was greater in venovenous-ECMO (1.15%) vs venoarterial-ECMO (−0.35%, P <.001). Overall, 81 patients (35%) experienced occult hypoxemia during ECMO. Occult hypoxemia was more common in venovenous-ECMO (65%) than in venoarterial-ECMO (17%, P <.001). In linear mixed-effects modeling, Sp o 2 underestimated Sa o 2 by 9.48% in central vs peripheral venoarterial-ECMO (95% CI, −17.1% to −1.79%; P =.02). Higher vasopressor dose equivalences significantly worsened the Sp o 2 −Sa o 2 discrepancy (P <.001). In linear mixed-effects modeling, Sp o 2 overestimated Sa o 2 by 25.43% in single lumen–cannulated vs double lumen–cannulated venovenous-ECMO (95% CI, 5.27%-45.6%; P =.03). Higher vasopressor dose equivalences and lactate dehydrogenase levels significantly worsened the Sp o 2 −Sa o 2 discrepancy (P <.001). Venovenous-ECMO patients are at higher risk for occult hypoxemia compared with venoarterial-ECMO. A higher vasopressor requirement and different cannulation strategies (central venoarterial-ECMO; single-lumen venovenous-ECMO) were significant factors for clinically significant Sp o 2 −Sa o 2 discrepancy in both ECMO modes. [Display omitted] [ABSTRACT FROM AUTHOR] |
| Databáze: |
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