Hyperoxia and mortality in conventional versus extracorporeal cardiopulmonary resuscitation

Stoll, Sandra Emily; Paul, Eldho; Pilcher, David; Udy, Andrew; Burrell, Aidan

doi:10.1016/j.jcrc.2022.154001

Cited by 8 publications

(12 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…As previously exposed, during the early phase of VA-ECMO support, the mixing zone is proximal in the aortic arch, and systemic oxygenation is mainly ensured by the oxygenator [ 10 ]. With an F S O 2 commonly set at 100% [ 13 – 15 ] for current oxygenator’s characteristics, P POST O 2 can rise to 500 mmHg at the membrane lung outlet [ 16 ]; thus, hyperoxemia is frequently observed on arterial blood gases sampled at the right radial artery [ 13 , 15 , 17 – 20 ]. In such setting, VA-ECMO can be responsible for brain and coronary hyperoxemia (Fig.…”

Section: Po 2 During Peripheral Va-ecmo Support: W...mentioning

confidence: 99%

“…Ross et al reported that they always maintain F S O 2 at 100% [ 13 ]. In the context of ECPR, Lamhaut et al set the F S O 2 at 50% immediately after ECMO start [ 28 ], while Chang et al set F S O 2 at 60% [ 17 ] and Halter and Stoll at 100% [ 14 , 15 ]. Taking together these studies, F S O 2 is usually set between 50 and 100% during the early phase of VA-ECMO support.…”

Section: What Do We Know About Daily Practice?mentioning

confidence: 99%

“…However, studies describing general oxygenation in VA-ECMO patients could provide some information. Using a threshold of PaO 2 ≥ 300 mmHg, the reported prevalence of severe hyperoxemia in the first 24 h ranged from 12 to 89% [ 13 – 15 , 17 – 19 , 29 ] (Table 1 ). In the study of Justus et al, the mean right radial P a O 2 was higher than 250 mmHg at day 1 and decreased between day 3 and day 10, ranging from 100 to 150 mmHg [ 20 ].…”

Section: What Do We Know About Daily Practice?mentioning

confidence: 99%

“…In the study of Justus et al, the mean right radial P a O 2 was higher than 250 mmHg at day 1 and decreased between day 3 and day 10, ranging from 100 to 150 mmHg [ 20 ]. In a retrospective study of 79 ECPR patients, the mean right radial P a O 2 over the 8 first days was 211 ± 58 mmHg [ 15 ]. Based on a study on ECPR, the median value of mean P a O 2 in the non-cannulated femoral artery during the first day was 328 mmHg (IQR 228–524) [ 19 ].…”

Section: What Do We Know About Daily Practice?mentioning

confidence: 99%

“…Observational studies, including two pediatric ones, have reported an association between hyperoxemia (usually sampled on right radial artery) and outcomes in VA-ECMO patients [ 14 , 15 , 17 – 19 , 29 – 33 ]. In these studies, severe hyperoxemia that is commonly defined by a P a O 2 ≥ 300 mmHg is frequently associated with worst outcomes (Table 1 ).…”

Section: Why Targeting Extracorporeal Moderate Hyperoxemia (P ...mentioning

confidence: 99%

See 4 more Smart Citations

Optimizing PO2 during peripheral veno-arterial ECMO: a narrative review

Winiszewski

Guinot

Schmidt³

et al. 2022

Crit Care

View full text Add to dashboard Cite

During refractory cardiogenic shock and cardiac arrest, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is used to restore a circulatory output. However, it also impacts significantly arterial oxygenation. Recent guidelines of the Extracorporeal Life Support Organization (ELSO) recommend targeting postoxygenator partial pressure of oxygen (PPOSTO2) around 150 mmHg. In this narrative review, we intend to summarize the rationale and evidence for this PPOSTO2 target recommendation. Because this is the most used configuration, we focus on peripheral VA-ECMO. To date, clinicians do not know how to set the sweep gas oxygen fraction (FSO2). Because of the oxygenator’s performance, arterial hyperoxemia is common during VA-ECMO support. Interpretation of oxygenation is complex in this setting because of the dual circulation phenomenon, depending on both the native cardiac output and the VA-ECMO blood flow. Such dual circulation results in dual oxygenation, with heterogeneous oxygen partial pressure (PO2) along the aorta, and heterogeneous oxygenation between organs, depending on the mixing zone location. Data regarding oxygenation during VA-ECMO are scarce, but several observational studies have reported an association between hyperoxemia and mortality, especially after refractory cardiac arrest. While hyperoxemia should be avoided, there are also more and more studies in non-ECMO patients suggesting the harm of a too restrictive oxygenation strategy. Finally, setting FSO2 to target strict normoxemia is challenging because continuous monitoring of postoxygenator oxygen saturation is not widely available. The threshold of PPOSTO2 around 150 mmHg is supported by limited evidence but aims at respecting a safe margin, avoiding both hypoxemia and severe hyperoxemia.

show abstract