High- versus Low-Flow Extracorporeal Respiratory Support in Experimental Hypoxemic Acute Lung Injury

• DOI: 10.1164/rccm.202212-2194oc
• Publication Date: 2023-02-27T18:04:10Z
• Authors: Serena Brusatori; Carmelo Zinnato; Mattia Busana; Federica Romitti; Simone Gattarello; Maria Michela Pal...; Tommaso Pozzi; Irene Steinberg; Paola Palermo; Stefano Lazzari; Roberta Maj; Mara Velati; Rosanna D’Albo; Jona Wassong; Killian Meissner; Fabio Lombardo; Peter Herrmann; Michael Quintel; Onnen Moerer; Luigi Camporota; John J. Marini; Konrad Meissner; Luciano Gattinoni
• Keywords: Extracorporeal

Rationale: In the ECMO to Rescue Lung Injury in Severe ARDS (EOLIA) trial, oxygenation was similar between intervention and conventional groups, while minute ventilation reduced group. Comparable reductions intensity are theoretically possible with low-flow extracorporeal CO2 removal (ECCO2R), provided that remains acceptable. Objectives: To compare effects of ECCO2R membrane (ECMO) on gas exchange, respiratory mechanics hemodynamics animal models pulmonary (intratracheal HCl) extra-pulmonary (intravenous oleic acid, OA) lung injury. Methods: 24 pigs moderate-severe hypoxemia (PaO2/FiO2≤150mmHg) were randomized (blood flow 50-60mL/kg/min), (0.4L/min) or mechanical alone. Measurements: Oxygen consumption, production, mechanics, presented as 24-hour average. Main results: OA vs HCl showed higher extravascular water (1424±419 574±195mL, p<0.001), worse (PaO2/FiO2 125±14 151±11mmHg, p<0.001) but better (plateau pressure 27±4 30±3cmH2O, p=0.017). Both led acute severe hypertension. both (3.7±0.5L/min), compared (0.4L/min), increased mixed venous SO2 oxygenation, improved (cardiac output 6.0±1.4 5.2±1.4L/min; p=0.003). consumption production – irrespective injury model lower during ECMO, resulting PaCO2, elastance (64±27 40±8cmH2O/L, p<0.001). Conclusions: associated oxygen hemodynamics. may offer a potential alternative concerns its This article is open access distributed under terms Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/).