The Early Change in Pa_CO2after Extracorporeal Membrane Oxygenation Initiation Is Associated with Neurological Complications

Extracorporeal life support for adults with acute respiratory distress syndrome

“…Although relatively infrequent in the EOLIA trial [ 16 ], intracranial hemorrhage is associated with poor outcomes. The rapidity with which CO 2 is reduced after ECLS initiation has been implicated in development of neurological complications and the sweep gas flow through the oxygenator should be adjusted to avoid a drop in PaCO 2 > 20 mm Hg/h over the first 24-h of ECMO in most patients [ 67 , 68 ]. Similarly, interactions between the blood, the pump, and the artificial surfaces of the circuit and membrane generate blood trauma and activate coagulation and fibrinolysis pathways associated with increased inflammatory responses.…”

Early PaCO2 Changes after Initiating Extracorporeal Membrane Oxygenation: Considerations for Future Research

“…We read with great interest the article by Cavayas et al in a recent issue of the American Journal of Respiratory and Critical Care Medicine (1). This group demonstrated that early changes in partial pressure of arterial carbon dioxide (PaCO 2 ) are associated with neurological complications in patients with severe respiratory failure who have undergone extracorporeal membrane oxygenation (ECMO).…”

Overcoming bleeding events related to extracorporeal membrane oxygenation in COVID-19 – Authors' reply

“…The association with PaCO 2 change was confirmed in a 2020 study of a large international registry, in which a greater than 50% decrease in PaCO 2 in the first 24 h of ECMO was independently associated with an increased incidence of neurological complications. 3 …”

“…Third, of the four patients with brain haemorrhage, three had a greater than 40% decrease in PaCO 2 in the first 24 h after ECMO initiation. 3 Lastly, we collected haemostasis parameters only in the 48 h preceding the event. Therefore, we cannot rule out that a haemostasis disorder might have caused intracranial bleeding several days before it was diagnosed by cranial CT scan, since neurological examination is complex in these patients who require deep sedation and frequent neuromuscular blockade.…”