Table 1.
Ventilatory, Hemodynamic, and Echocardiographic Data Before and After Venovenous Extracorporeal Membrane Oxygenation Cannulation
| Variables | Before V-V ECMO cannulation | After V-V ECMO cannulation | p value |
|---|---|---|---|
| Ventilatory variables | |||
| Minute ventilation (L/min) | 10.8 (8.6-11.0) | 1.3 (0.5-2.5) | <0.01 |
| Tidal volume (mL) | 380 (300-410) | 150 (58-267) | <0.01 |
| Tidal volume (mL/kg PBW) | 5.2 (5.0-6.2) | 2.0 (0.9-3.6) | <0.01 |
| Respiratory rate (breaths/min) | 30 (25-32) | 10 (10-10) | <0.01 |
| Pplat (cmH2O) | 30 (30-34) | 20 (20-20) | <0.01 |
| ΔP (cmH2O) | 18 (18-20) | 10 (10-10) | <0.01 |
| PEEP (cmH2O) | 10 (8-15) | 10 (10-10) | 0.45 |
| Crs (mL/cmH2O)* | 21 (19-23) | 9 (6-24) | 0.08 |
| FIO2 (%) | 100 (80-100) | 50 (50-50) | <0.01 |
| PaO2 (mmHg) | 69 (62-77) | 92 (72-135) | 0.02 |
| PaO2/FIO2 (mmHg) | 80 (62-87) | n.a. | n.a. |
| SaO2 (%) | 93 (85-95) | 96 (94-97) | 0.02 |
| PaCO2 (mmHg) | 55 (49-69) | 47 (42-50) | 0.06 |
| pH | 7.35 (7.19-7.44) | 7.35 (7.30-7.39) | 0.63 |
| Hemodynamic variables | |||
| Heart rate (beats/min) | 105 (93-124) | 95 (85-105) | 0.18 |
| Mean arterial pressure (mmHg) | 76 (68-81) | 76 (67-81) | 0.83 |
| Norepinephrine dose (µg/kg/min) | 0.00 (0.00-0.25) | 0.14 (0.06-0.31) | 0.04 |
| Vasopressin dose (U/h) | 0 (0-0) | 0 (0-1) | 0.03 |
| Lactate (mmol/L) | 1.9 (1.6-3.5) | 2.2 (1.8-4.3) | 0.46 |
| Fluid balance (mL)† | +1462 (653-3067) | +838 (-37-2268) | 0.55 |
| Echocardiographic variables | |||
| RV basal diameter (cm)‡ | 3.9 (3.6-4.4) | 4.3 (3.8-4.5) | 0.29 |
| RV dilatation (n/%)‡ | 6 (37) | 5 (55) | 0.16 |
| TAPSE (mm) § | 15 (13-20) | 15 (13-18) | 0.41 |
| RV S' (cm/s)|| | 11.0 (9.0-12.0) | 12.0 (9.5-13.5) | 0.61 |
| RVFAC (%)¶ | 29 (22-34) | 23 (20-29) | 0.18 |
| RVD (n/%)⁎⁎ | 9 (64%) | 6 (50%) | 0.08 |
| RVSP (mmHg)†† | 58 (43-79) | 46 (34-62) | 0.02 |
| LVEF (%)‡‡ | 60 (60-63) | 60 (48-63) | 0.28 |
Data are reported as median (interquartile range) or number (percentage), as appropriate. Wilcoxon matched-pairs signed-rank test and McNemar test were applied, as appropriate; p values < 0.05 were considered significant.
Crs, static respiratory system compliance; ΔP, driving pressure; FIO2, fraction of inspired oxygen; LVEF, left ventricular ejection fraction; n.a., not applicable due to difficulty in determining the capillary oxygen content without precise estimations of patient's cardiac output; PaCO2, arterial partial pressure of carbon dioxide; PaO2, arterial partial pressure of oxygen; PBW, predicted body weight; PEEP, positive end-expiratory pressure; Pplat, plateau pressure; RV, right ventricle; RVD, RV dysfunction; RVFAC, fractional area change of the RV; RV S', pulsed Doppler S wave of the RV; RVSP, RV systolic pressure; SaO2, arterial oxygen saturation; TAPSE, tricuspid annular plane systolic excursion; V-V ECMO, venovenous extracorporeal membrane oxygenation.
Data available for 9 of 18 patients before cannulation and 17 of 18 patients after cannulation.
Defined as 24-hour fluid balance for the midnight before the echocardiographic exam. Data available for 6 of 18 patients before cannulation and 13 of 18 patients after cannulation.
RV dilatation is defined as RV basal diameter > 4.1 cm (Lang et al.4). Data available for 16 of 18 patients before cannulation and 9/18 patients after cannulation.
Data available for 14 of 18 patients before cannulation and 12 of 18 patients after cannulation.
Data available for 11 of 18 patients before cannulation and 11 of 18 patients after cannulation.
Data available for 6 of 18 patients before cannulation and 4 of 18 patients after cannulation.
Defined as TAPSE < 17 mm, RV S' < 9.5 cm/s, or RVFAC < 35% (Lang et al.4). Data available for 14/18 patients before cannulation and 12/18 patients after cannulation.
RVSP was determined from peak tricuspid regurgitation jet velocity and an estimate of the right atrial pressure (Rudski et al.5). Data available for 11 of 18 patients before cannulation and 10/18 patients after cannulation.
Data available for 13 of 18 patients before cannulation and 13 of 18 patients after cannulation.