Abstract
To determine the effects of bladderbox alarms during venoarterial extracorporeal membrane oxygenation (va-ECMO) on cerebral oxygenation and hemodynamics, six lambs were prospectively treated with va-ECMO and bladderbox alarms were simulated. Changes in concentrations of oxyhemoglobin (ΔcO2Hb), deoxyhemoglobin (ΔcHHb), and total Hb (ΔctHb) were measured using near infrared spectrophotometry. Fluctuations in Hb oxygenation index (ΔHbD) and cerebral blood volume (ΔCBV) were calculated. Heart rate (HR), mean arterial pressure (MAP), blood flow in the left carotid artery (Qcar), and central venous pressure (CVP) were registered. Bladderbox alarms were simulated by increasing the ECMO flow or partially clamping the venous cannula and resolved by decreasing the ECMO flow, unclamping the cannula, or intravascular volume administration. CBV, HbD, MAP, and Qcar decreased significantly during bladderbox alarms, whereas HR and CVP increased. After the bladderbox alarms, CBV and HbD increased significantly to values above baseline. For HbD, this increase was higher during intravascular volume administration. MAP, Qcar, and CVP recovered to preexperiment values but increased further with volume administration. HR was increased at the end of our measurements. We conclude that Bladderbox alarms during va-ECMO treatment result in significant fluctuations in cerebral oxygenation and hemodynamics, a possible risk factor for intracranial lesions.
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Abbreviations
- AR:
-
cerebral autoregulation
- ΔCBV:
-
changes in cerebral blood volume
- cHb:
-
concentration of hemoglobin in circulating blood
- ΔcHHb:
-
changes in concentration deoxyhemoglobin
- ΔctHb:
-
changes in concentration of total hemoglobin
- ΔcO2Hb:
-
changes in concentration of oxyhemoglobin
- CVP:
-
central venous pressure
- ΔHbD:
-
changes in hemoglobin oxygenation index
- HR:
-
heart rate
- ICH:
-
intracranial hemorrhage
- MAP:
-
mean arterial pressure
- NIRS:
-
near infrared spectrophotometry
- Qcar:
-
blood flow in the left carotic artery
- Sao2:
-
arterial oxygen saturation
- va-ECMO:
-
venoarterial extracorporeal membrane oxygenation
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de Mol, A., Gerrits, L., van Heijst, A. et al. Effect of Bladderbox Alarms During Venoarterial Extracorporeal Membrane Oxygenation on Cerebral Oxygenation and Hemodynamics in Lambs. Pediatr Res 66, 688–692 (2009). https://doi.org/10.1203/PDR.0b013e3181bce55c
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DOI: https://doi.org/10.1203/PDR.0b013e3181bce55c
